HIMSS Immunization Integration Program CDC Modular Test Plan v11

Test Story

1. High Level Description of Capabilities and Functions Included in Essentials Module

Test Story

Description

The current IIP test plan includes eight capabilities. Each of these capabilities describes workflow-related concepts that group together common testable actions. The change from prior versions of the IIP test plan provides greater clarity regarding the intent and purpose of each grouping. Current capabilities include:

  • Test Preparation – Data Load and PH Configuration
    • Facilities
    • People
    • Vaccine Inventory
    • Public Health Configuration

  • Care Provision and Documentation
    • Select Patients
    • Enter patient provided immunization related information
    • Display patient's updated immunization local system (non-IIS) forecast
    • Enter vaccination order
    • Record vaccines with 2D barcode scanner and manually (no barcode scanner)
    • Produce printable version of patient's immunization record
    • Display a patient’s local immunization forecast after adding vaccine administration events to the immunization history
    • Vaccine dose expiration is visually apparent to administering practitioner
    • Identify and record publicly provided-vaccine program eligibility
    • Record adverse events
    • Inform users of risks due to previous adverse events within the ordering or administering workflows for potential causative agents
    • Record vaccine administration refusal
    • Produce cohort reports

  • Query, Response and Reconciliation
    • Display local forecast
    • Transmit query to the IIS and receive response
    • Compare IIS-provided information
    • Display SUT vaccination history including the user-reconciled IIS-provided history
    • Re-evaluate patient’s immunization forecast
    • Not an exact match response (RSP)

  • Transmission and Acknowledgment

    • Transmit newly recorded immunization records to IIs
    • Receive and process acknowledgement messages
    • Update vaccine record previously submitted to IIS
    • Transmit newly recorded historical immunization record
    • Transmit and delete record and for immunization
    • Transmit refusal for immunization
    • Transmit patient consent (protection status)

  • Patient Access
    • Provide patient or a designated individual electronic access to the patient’s immunization record.

  • Clinical Configuration
    • Add new vaccine codes
    • Update immunization schedule to reflect changes in ACIP recommendations

  • Transport
    • Send and receive immunization messages using the CDC WSDL

  • Data Quality
    • Prevention of critical date data entry errors.

1.1. Crosswalk for patient by patient workflow

Test Story

Description

Please use the crosswalk located here: under user documents>HIMSS IIP Test Plan v11.0 Crosswalk


2. 2.0.0 Test preparation - data load

Test Story

Description

This provides the data that should exist in the system under test before testing scenarios are performed.




Post-Condition

Data listed in the test cases listed in this test plan exist in the system under test.



Test Objectives

Mother's maiden name is expected to be populated for all minor patient.


Middle names are expected to be populated for all patients.


Middle names for next of kin are expected to be populated for all patients.


Phone number and email (if provided with patient data load) is expected to be populated for all patients.

The SUT SHALL link standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.



Evaluation Criteria

This is a non-evaluated test step that must be performed to support other associated steps.

This was an attestation item-previously attested to.

This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.


Notes

This activity is not performed under proctor observation.


2.1. 2.1.0 Facilities

Test Story

Description

This provides the details for facilities that should exist in the system under test before testing scenarios are performed.

Some additional identifiers listed under data entry are only needed for specific tests where additional MSH fields or OIDs are being requested.


Data Entry

SUT Organization/Facility/Assigning Authority Definitions

Organization Facility
Organization Identifier197028
Identifier Type CodeXX
Assigning Authority-Namespace IDOFM
Organization Name Oregon Family Medicine
Address
Address Line 12000 N. 19th St.
Address Line 2[None]
CitySpringfield
StateOregon
Zip Code 97477 
CountryUSA
Universal ID2.16.840.1.113883.3.72.5.40.8
Universal ID TypeISO


Sending Application - SUT (Message Header)

Software Application Namespace IDSUT-APP
Universal ID2.16.840.1.113883.3.72.5.40.1
Universal ID TypeISO


Sending Facility - SUT (Message Header)

Facility-Namespace IDOFM
Universal ID2.16.840.1.113883.3.72.5.40.2
Universal ID TypeISO


Patient Identifier Assigning Authority (PID-3)

Assigning Authority-Namespace IDIIP-MPI-1
Universal ID2.16.840.1.113883.3.72.5.40.5
Universal ID TypeISO


Practitioner Assigning Authority (ORC-10, ORC-12, RXA-10)

Assigning Authority-Namespace IDOFM-PI-1
Universal ID2.16.840.1.113883.3.72.5.40.7
Universal ID TypeISO


Administered At-Location (RXA-11.4) 

Facility-Namespace IDOFM
Universal ID2.16.840.1.113883.3.72.5.40.12
Universal ID TypeISO


Order Information Assigning Authority Information (ORC)

Placer Order Number-Entity IdentifierUnique per order
Namespace IDOFM
Universal ID2.16.840.1.113883.3.72.5.40.10
Universal ID TypeISO
Filler Order Number-Entity IdentifierUnique per order
Namespace IDOFM
Universal ID2.16.840.1.113883.3.72.5.40.10
Universal ID TypeISO


IIP NIST Tool Organization/Facility/Assigning Authority Definitions

IIP Facility (Receiving Responsible Organization – IIP NIST Tool)

Organization Identifier197027
Identifier Type CodeXX
Assigning Authority-Namespace ID IIP
Organization Name Immunization Integration Program
Assigning Authority-Namespace ID IIP
Universal ID2.16.840.1.113883.3.72.5.40.9
Universal ID TypeISO


Receiving Application (Message Header)

Software Application Namespace IDIIP-IIS-APP
Universal ID2.16.840.1.113883.3.72.5.40.3
Universal ID TypeISO


Receiving Facility (Message Header)

Facility-Namespace IDIIP
Universal ID2.16.840.1.113883.3.72.5.40.4
Universal ID TypeISO

Post-Condition

Data listed in the test cases listed below exist in the system under test.



Notes

This activity is not performed under proctor observation.


This was an attestation item-previously attested to.



2.2. 2.2.0 People

Test Story

Description

This provides the details for people (patients and providers) that should exist in the system under test before testing scenarios are performed.



Post-Condition

Data listed in the test cases listed below exist in the system under test.



Notes

This activity is not performed under proctor observation.

The Protection Indicator is the consent to share information with the registry. When marking if the patient has consented or not consented the applicable field, PD1-12 shall be marked with  "Y" =Yes, protect my information (No consent) or "N" =No, do not protect my information (Consent).

This was an attestation item-previously attested to.



2.2.1. Patient Pre-load: Lance Gaige Duncan (LGD)

Test Step Type: SUT_MANUAL

Test Story

Description

This step provides the details for the patient that should exist in the system under test before testing scenarios are performed.

Functions associated with this patient: 3.1.0, 3.2.0, 3.3.0, 3.4.0, 3.5.0, 3.6.0, 3.7.0, 3.8.0, 3.9.0, 5.1.0, 5.2.0, 5.3.0, 5.4.0

Name abbreviated in Function and Test Step title as: LGD



Comments

Please use the Job Aid for all steps associated to this patient that require forecast dates and DOB dates.

The Job Aid can be located here in NIST under Documentation> User Documentation>HIMSS IIP Test Plan v11.0 Job Aid


Pre-condition
Patient 1
ID Number1111
ID TypeMedical record number
Name
FirstLance
MiddleGaige
LastDuncan
SuffixJr.
Mother's Maiden NameKing
AgeToday (day of test) the patient is 0 years, 1 months, and 17 days old
Relative Date of BirthPlease use the Job Aid for all steps related to this patient
SexMale
RaceAmerican Indian or Alaska Native
EthnicityNot Hispanic or Latino
Permanent Address
Address Line 1749 Evergreen Ter.
Address Line 2Unit A
CitySpringfield
StateOR
Zip Code97477
CountryUSA
Phone Number(541) 555-1111
UsePrimary Residence Number
TypeCellular Phone
EmailIIPMP@gmail.com
UseNetwork (email) Address
TypeX.400 email address: Use Only If Telecommunication Use Code Is NET
Part of a multiple birth?No
Birth order1
Reminder RecallReminder/recall - any method
Protection Indicator: Consent= (No) /No Consent =(Yes)
No
IIS StatusActive
Deceased?No
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native


Patient 1's Next of Kin 1


Name
FirstIngrid
MiddleStacy
LastDuncan
 Maiden NameKing
RelationMother
Permanent Address
Address Line 1749 Evergreen Ter.
Address Line 2Unit A
CitySpringfield
StateOR
Zip Code97477
CountryUSA
Phone Number(541) 555-1111
UsePrimary Residence Number
TypeCellular Phone
EmailIIPMP@gmail.com
UseNetwork (email) Address
TypeX.400 email address: Use Only If Telecommunication Use Code Is NET


Patient 1's Next of Kin 2
Name
FirstSimon
MiddleIsaiah
LastDuncan

Sr.
Maiden Name
RelationFather
Permanent Address
Address Line 1749 Evergreen Ter.
Address Line 2Unit A
CitySpringfield
StateOR
Zip Code97477
CountryUSA
Phone Number(541) 555-1233
UsePrimary Residence Number
TypeCellular Phone

Post-Condition

Data listed in this test case exists in the system under test.



Test Objectives

Patient Pre-load


Notes

The Protection Indicator is the consent to share information with the registry. When marking if the patient has consented or not consented the applicable field, PD1-12 shall be marked with  "Y" =Yes, protect my information (No consent) or "N" =No, do not protect my information (Consent).



2.2.2. Patient Pre-load: Alexandria Jacqueline Montoya (AJM)

Test Step Type: SUT_MANUAL

Test Story

Description

This step provides the details for the patient that should exist in the system under test before testing scenarios are performed.

Functions associated with this patient: 3.10.0, 3.11.0, 5.7.0

Name abbreviated in Function and Test Step title as: AJM


Pre-condition
Patient 2
ID Number2222
ID TypeMedical record number
Name
FirstAlexandria
MiddleJacqueline
LastMontoya
Suffix
Mother's Maiden NameHayes
Date of Birth03/27/2012
SexFemale
RaceWhite
EthnicityNot Hispanic or Latino
Permanent Address
Address Line 182 Evergreen Ter
Address Line 2
CitySpringfield
StateOR
Zip Code97477
CountryUSA
Phone Number(541) 555-1235
UsePrimary Residence Number
TypeCellular Phone
Part of a multiple birth?No
Birth order1
Reminder RecallReminder/recall - any method
Protection Indicator: Consent= (No) /No Consent =(Yes)
Yes
IIS StatusActive
Deceased?No
Vaccine Program EligibilityVFC eligible - Medicaid/Medicaid Managed Care
Patient 2's Next of Kin


Name
FirstMaria
MiddleChristina
LastMontoya
 Maiden NameHayes
RelationMother
Permanent Address
Address Line 182 Evergreen Ter
Address Line 2
CitySpringfield
StateOR
Zip Code97477
CountryUSA
Phone Number(541) 555-1235
UsePrimary Residence Number
TypeCellular Phone

Post-Condition

Data listed in this test case exists in the system under test.



Test Objectives

Patient Pre-load


Notes

The Protection Indicator is the consent to share information with the registry. When marking if the patient has consented or not consented the applicable field, PD1-12 shall be marked with  "Y" =Yes, protect my information (No consent) or "N" =No, do not protect my information (Consent).



2.2.3. Patient Pre-load: Selma Nadia McKay (SNM)

Test Step Type: SUT_MANUAL

Test Story

Description

This step provides the details for the patient that should exist in the system under test before testing scenarios are performed.

Functions associated with this patient: 3.12.0, 3.13.0, 4.1.0, 4.2.0, 4.3.0, 4.4.0, 4.5.0

Name abbreviated in Function and Test Step title as: SNM



Pre-condition
Patient 3
ID [1] (Local)
ID Number3333
ID TypeMedical record number
Name
FirstSelma
MiddleNadia
LastMcKay
Suffix
Mother's Maiden NameSchroeder
Date of Birth02/05/2023
SexFemale
RaceBlack or African American
EthnicityNot Hispanic or Latino
Permanent Address
Address Line 1600 Cherry Rd.
Address Line 2
CitySpringfield
StateOR
Zip Code97477
CountryUSA
Phone Number(541) 555-1236
UsePrimary Residence Number
TypeTelephone
Part of a multiple birth?Yes
Birth order1
Reminder RecallReminder/recall - any method
Protection Indicator: Consent= (No) /No Consent =(Yes)
No
IIS StatusActive
Deceased?No
Vaccine Program EligibilityNot VFC eligible


Patient 3's Next of Kin 1


Name
FirstAngeline
MiddleIngrid
LastMcKay
 Maiden NameSchroeder
RelationMother
Permanent Address
Address Line 1600 Cherry Rd.
Address Line 2
CitySpringfield
StateOR
Zip Code97477
CountryUSA
Phone Number(541) 555-1236
UsePrimary Residence Number
TypeTelephone


Patient 3's Known Immunization History
Vaccine trade name, Unit-of-Use  NDCENGERIX-B 58160-0820-43
Vaccine type (CVX Code)Hep B, adolescent or pediatric (CVX 08)
ManufacturerGlaxoSmithKline
Administered on02/05/2023
Lot NumberTTT44891
Expiration Date3/5/2024
Volume (mL)0.50
Administered AtOregon Birthing Hospital
Vaccine record sourceHistorical information - from other provider


Vaccine trade name, Unit-of-Use  NDCHAVRIX 58160-0825-43
Vaccine type (CVX Code)Hep A, ped/adol, 2 dose (CVX 83)
ManufacturerGlaxoSmithKline
Administered on12/22/2023
Lot NumberHA1111
Expiration Date3/22/2025
Volume (mL)0.50
Administered atChain Pharmacy of Oregon
Vaccine record sourceHistorical information - from other provider

Post-Condition

Data listed in this test case exists in the system under test.



Test Objectives

Patient Pre-load


Notes

The Protection Indicator is the consent to share information with the registry. When marking if the patient has consented or not consented the applicable field, PD1-12 shall be marked with  "Y" =Yes, protect my information (No consent) or "N" =No, do not protect my information (Consent).



2.2.4. Patient Pre-load: Deborah Charlotte McKay (DCM)

Test Step Type: SUT_MANUAL

Test Story

Description

This step provides the details for the patient that should exist in the system under test before testing scenarios are performed.

Functions associated with this patient: 3.14.0, 5.5.0, 5.6.0

Name abbreviated in Function and Test Step title as: DCM



Pre-condition
Patient 4
ID [1] (Local)
ID Number4444
ID TypeMedical record number
Name [1]
FirstDeborah
MiddleCharlotte
LastMcKay
Suffix
Name [2] (IIS Name)
FirstDebbie
MiddleCharlotte
LastMcKay
Suffix
Mother's Maiden NameSchroeder
Date of Birth02/05/2023
SexFemale
RaceBlack or African American
EthnicityNot Hispanic or Latino
Permanent Address
Address Line 1600 Cherry Rd.
Address Line 2
CitySpringfield
StateOR
Zip Code97477
CountryUSA
Phone Number(541) 555-1236
UsePrimary Residence Number
TypeTelephone
Part of a multiple birth?Yes
Birth order2
Reminder RecallReminder/recall - any method
Protection Indicator: Consent= (No) /No Consent =(Yes)
No
IIS StatusActive
Deceased?No
Vaccine Program EligibilityNot VFC eligible


Patient 4's Next of Kin 1


Name
FirstAngeline
MiddleIngrid
LastMcKay
 Maiden NameSchroeder
RelationMother
Permanent Address
Address Line 1600 Cherry Rd.
Address Line 2
CitySpringfield
StateOR
Zip Code97477
CountryUSA
Phone Number(541) 555-1236
UsePrimary Residence Number
TypeTelephone


Patient 4's Known Immunization History
Vaccine trade name, Unit-of-Use  NDCENGERIX-B 58160-0820-43
Vaccine type (CVX Code)Hep B, adolescent or pediatric (CVX 08)
ManufacturerGlaxoSmithKline
Administered on02/05/2023
Lot NumberTTT44891
Expiration Date3/5/2024
Volume (mL)0.50
Administered AtOregon Birthing Hospital
Vaccine record sourceHistorical information - from other provider

Post-Condition

Data listed in this test case exists in the system under test.



Test Objectives

Patient Pre-load


Notes

The Protection Indicator is the consent to share information with the registry. When marking if the patient has consented or not consented the applicable field, PD1-12 shall be marked with  "Y" =Yes, protect my information (No consent) or "N" =No, do not protect my information (Consent).



2.2.5. Patient Pre-load: Franklin Mayhew Nesbitt (FMN)

Test Step Type: SUT_MANUAL

Test Story

Description

This step provides the details for the patient that should exist in the system under test before testing scenarios are performed.

Steps associated with this patient: 4.6.4, 4.6.5, 4.6.6

Name abbreviated in Function and Test Step title as: FMN


Pre-condition
Patient 5 No match patient
ID Number5555
ID TypeMedical record number
Name
FirstFranklin
MiddleMayhew
LastNesbitt
Suffix
Date of Birth04/05/1984
SexMale
Race¹Asian
Ethnicity¹Not Hispanic or Latino
Permanent Address¹
Address Line 1¹400 Fir Rd.
Address Line 2
City¹Springfield
State¹OR
Zip Code¹97477
Country¹USA
Phone Number¹(541) 555-1209
Use¹Primary Residence Number
Type¹Telephone
Part of a multiple birth?¹No
Birth order¹1
Reminder Recall¹Reminder/recall - any method
Protection Indicator¹: Consent= (No) /No Consent =(Yes)
No
IIS Status¹Active
Deceased?¹No
Vaccine Program Eligibility¹Not VFC eligible


¹ - If required by the SUT

Post-Condition

Data listed in this test case exists in the system under test.



Test Objectives

Patient Pre-load


Notes

The Protection Indicator is the consent to share information with the registry. When marking if the patient has consented or not consented the applicable field, PD1-12 shall be marked with  "Y" =Yes, protect my information (No consent) or "N" =No, do not protect my information (Consent).



2.2.6. Patient Pre-load: James John Smith (JJS)

Test Step Type: SUT_MANUAL

Test Story

Description

This step provides the details for the patient that should exist in the system under test before testing scenarios are performed.

Steps associated with this patient: 4.6.1, 4.6.2, 4.6.3

Name abbreviated in Function and Test Step title as: JJS


Pre-condition
Patient 6 (This the patient with a common name)
ID Number6666
ID TypeNo
Name
FirstJames
MiddleJohn
LastSmith
Suffix
Date of Birth04/05/1974
SexMale
Race¹Black or African American
Ethnicity¹Not Hispanic or Latino
Permanent Address¹
Address Line 1¹600 Locust Ln
Address Line 2
City¹Springfield
State¹OR
Zip Code¹97477
Country¹USA
Phone Number¹(541) 555-0006
Use¹Primary Residence Number
Type¹Telephone
Part of a multiple birth?¹No
Birth order¹1
Reminder Recall¹Reminder/recall - any method
Protection Indicator¹: Consent= (No) /No Consent =(Yes)
No
IIS Status¹Active
Deceased?¹No
Vaccine Program Eligibility¹Not VFC eligible


¹ - If required by the SUT

Post-Condition

Data listed in this test case exists in the system under test.



Test Objectives

Patient Pre-load


Notes

The Protection Indicator is the consent to share information with the registry. When marking if the patient has consented or not consented the applicable field, PD1-12 shall be marked with  "Y" =Yes, protect my information (No consent) or "N" =No, do not protect my information (Consent).



2.2.7. Patient Pre-load: Finley Ira Nash (FIN)

Test Step Type: SUT_MANUAL

Test Story

Description

This step provides the details for the patient that should exist in the system under test before testing scenarios are performed.

Functions associated with this patient: 7.0.0

Name abbreviated in Function and Test Step title as: FIN



Pre-condition
Patient 7
ID Number7777
ID TypeMedical record number
Name
FirstFinley
MiddleIra
LastNash
Suffix
Date of Birth04/05/1966
SexMale
Race¹Asian
Ethnicity¹Hispanic or Latino
Permanent Address¹
Address Line 1¹700 Locust Ln
Address Line 2
City¹Springfield
State¹OR
Zip Code¹97477
Country¹USA
Phone Number¹(541) 555-0007
Use¹Primary Residence Number
Type¹Cellular Phone
Part of a multiple birth?¹No
Birth order¹1
Reminder Recall¹Reminder/recall - any method
Protection Indicator¹: Consent= (No) /No Consent =(Yes)
No
IIS Status¹Active
Deceased?¹No


Vaccine Program EligibilityNot VFC eligible
¹ - If required by the SUT

Post-Condition

Data listed in this test case exists in the system under test.



Test Objectives

Patient Pre-load


Notes

The Protection Indicator is the consent to share information with the registry. When marking if the patient has consented or not consented the applicable field, PD1-12 shall be marked with  "Y" =Yes, protect my information (No consent) or "N" =No, do not protect my information (Consent).



2.2.8. Practitioner Pre-load: Daniela Jennifer Wyatt

Test Step Type: SUT_MANUAL

Test Story

Description

This step provides the details for the practitioner that should exist in the system under test before testing scenarios are performed.



Pre-condition
Administering Practitioner Person 1
ID7824
ID TypeProvider number
Name
FirstDaniela
MiddleJennifer
LastWyatt


Medical profession:Nurse (RN)

Post-Condition

Data listed in this test case exists in the system under test.



Test Objectives

Practitioner Pre-load


2.2.9. Practitioner Pre-load: Ramon Michael Bradshaw

Test Step Type: SUT_MANUAL

Test Story

Description

This step provides the details for the practitioner that should exist in the system under test before testing scenarios are performed.



Pre-condition
Order Data Entry & Ordering Practitioner 1
ID654
ID TypeMedical License number
Name
FirstRamon
MiddleMichael
LastBradshaw


Medical profession:Physician (MD)

Post-Condition

Data listed in this test case exists in the system under test.



Test Objectives

Practitioner Pre-load


2.3. 2.3.0 Vaccine Inventory

Test Story

Description

This provides the details for vaccine products that should exist in the system under test before testing scenarios are performed.

This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.


Data Entry

Inventory

Item 1
Product Name (This may vary with each implementation)PEDIARIX 58160-0811-43
Unit-of-Sale (Box) NDC58160-0811-52
Unit-of-Use (Syringe or Vial) NDC58160-0811-43
Generic NameDTaP-Hep B-IPV
ManufacturerGlaxoSmithKline
Lot NumberIIPVAXN01
Expiration Date9/27/2029
Funding SourcePublic
Doses on Hand10


 
CVX Code110
MVX CodeSKB


Funding Source CodeVXC50
Packaging10 pack – 1 dose syringe
Trade NamePEDIARIX
Unit-of-Use (Vial/Syringe) Image
GTIN10358160811439

(01)10358160811439(17)290927(10)IIPVAXN01


Item 2
Product Name (This may vary with each implementation)RECOMBIVAX HB 00006-4981-01
Unit-of-Sale (Box) NDC00006-4981-00
Unit-of-Use (Syringe or Vial) NDC00006-4981-01
Generic NameHep B, adolescent or pediatric
ManufacturerMerck and Co., Inc.
Lot NumberIIPVAXN02
Expiration Date9/27/2029
Funding SourcePublic
Doses on Hand10


 
CVX Code08
MVX CodeMSD


Funding Source CodeVXC50
Packaging10 pack – 1 dose vial
Trade NameRECOMBIVAX HB
Unit-of-Use (Vial/Syringe) Image
GTIN00300064981018

(01)00300064981018(17)290927(10)IIPVAXN02


Item 3
Product Name (This may vary with each implementation)ENGERIX-B 58160-0821-05
Unit-of-Sale (Box) NDC58160-0821-34
Unit-of-Use (Syringe or Vial) NDC58160-0821-05
Generic NameHep B, adult
ManufacturerGlaxoSmithKline
Lot NumberIIPVAXN03
Expiration Date9/27/2029
Funding SourcePrivate funds
Doses on Hand10


 
CVX Code43
MVX CodeSKB


Funding Source CodePHC70
PackagingUnknown
Trade NameENGERIX-B
Unit-of-Use (Vial/Syringe) Image
GTIN10358160821056

(01)10358160821056(17)290927(10)IIPVAXN03


Item 4
Product Name (This may vary with each implementation)ENGERIX-B 58160-0820-43
Unit-of-Sale (Box) NDC58160-0820-52
Unit-of-Use (Syringe or Vial) NDC58160-0820-43
Generic NameHep B, adolescent or pediatric
ManufacturerGlaxoSmithKline
Lot NumberIIPVAXN04
Expiration Date9/27/2029
Funding SourcePublic
Doses on Hand10


 
CVX Code08
MVX CodeSKB


Funding Source CodeVXC50
Packaging10 pack – 1 dose syringe
Trade NameENGERIX-B
Unit-of-Use (Vial/Syringe) Image
GTIN10358160820431

(01)10358160820431(17)290927(10)IIPVAXN04


Item 5
Product Name (This may vary with each implementation)ActHIB 49281-0547-58
Unit-of-Sale (Box) NDC49281-0545-03
Unit-of-Use (Syringe or Vial) NDC49281-0547-58
Generic NameHib (PRP-T)
Manufacturersanofi pasteur
Lot NumberIIPVAXN05
Expiration Date9/27/2029
Funding SourcePublic
Doses on Hand5


 
CVX Code48
MVX CodePMC


Funding Source CodeVXC50
Packaging5 pack – 1 dose vial
Trade NameActHIB
Unit-of-Use (Vial/Syringe) Image
GTIN00349281547584

(01)00349281547584(17)290927(10)IIPVAXN05


Item 6
Product Name (This may vary with each implementation)Prevnar 20 00005-2000-01
Unit-of-Sale (Box) NDC00005-2000-10
Unit-of-Use (Syringe or Vial) NDC00005-2000-01
Generic Name (CVX 216)Pneumococcal conjugate PCV20, polysaccharide CRM197 conjugate, adjuvant, PF
ManufacturerPfizer, Inc
Lot NumberLLBUAYMO6
Expiration Date9/27/2029
Funding SourcePublic
Doses on Hand10


 
CVX Code216
MVX CodePFR


Funding Source CodeVXC50
Packaging10 pack – 1 dose syringe
Trade NamePrevnar 20


Item 7
Product Name (This may vary with each implementation)Rotarix 58160-0740-02
Unit-of-Sale (Box) NDC58160-0740-21
Unit-of-Use (Syringe or Vial) NDC58160-0740-02
Generic Namerotavirus, monovalent
ManufacturerGlaxoSmithKline
Lot NumberIIPVAXN07
Expiration Date9/27/2029
Funding SourcePublic
Doses on Hand10


 
CVX Code119
MVX CodeSKB


Funding Source CodeVXC50
Packaging10 pack – 1 oral dose
Trade NameRotarix
Unit-of-Use (Vial/Syringe) Image
GTIN10358160740029

(01)10358160740029(17)290927(10)IIPVAXN07


Item 8
Product Name (This may vary with each implementation)GARDASIL 9 00006-4121-01
Unit-of-Sale (Box) NDC00006-4121-02
Unit-of-Use (Syringe or Vial) NDC00006-4121-01
Generic NameHPV9
ManufacturerMerck and Co., Inc.
Lot NumberIIPVAXN08
Expiration Date9/27/2029
Funding SourcePrivate funds
Doses on Hand10


 
CVX Code165
MVX CodeMSD


Funding Source CodePHC70
Packaging10 pack – 1 dose syringe
Trade NameGARDASIL 9
Unit-of-Use (Vial/Syringe) Image
GTIN00300064121018

(01)00300064121018(17)290927(10)IIPVAXN08


Item 9
Product Name (This may vary with each implementation)GARDASIL 9 00006-4121-01
Unit-of-Sale (Box) NDC00006-4121-02
Unit-of-Use (Syringe or Vial) NDC00006-4121-01
Generic NameHPV9
ManufacturerMerck and Co., Inc.
Lot NumberIIPVAXN09
Expiration Date3/26/2024
Funding SourcePublic
Doses on Hand10


 
CVX Code165
MVX CodeMSD


Funding Source CodeVXC50
Packaging10 pack – 1 dose syringe
Trade NameGARDASIL 9
Unit-of-Use (Vial/Syringe) Image
GTIN00300064121018

(01)00300064121018(17)240326(10)IIPVAXN09


Item 10
Product Name (This may vary with each implementation)PEDIARIX 58160-0811-43
Unit-of-Sale (Box) NDC58160-0811-52
Unit-of-Use (Syringe or Vial) NDC58160-0811-43
Generic NameDTaP-Hep B-IPV
ManufacturerGlaxoSmithKline
Lot NumberIIPVAXN10
Expiration Date9/27/2029
Funding SourcePrivate funds
Doses on Hand10


 
CVX Code110
MVX CodeSKB


Funding Source CodePHC70
Packaging10 pack – 1 dose syringe
Trade NamePEDIARIX
Unit-of-Use (Vial/Syringe) Image
GTIN10358160811439

(01)10358160811439(17)290927(10)IIPVAXN10


Item 11
Product Name (This may vary with each implementation)HAVRIX 58160-0825-43
Unit-of-Sale (Box) NDC58160-0825-52
Unit-of-Use (Syringe or Vial) NDC58160-0825-43
Generic NameHep A, ped/adol, 2 dose
ManufacturerGlaxoSmithKline
Lot NumberIIPVAXN11
Expiration Date9/27/2029
Funding SourcePrivate funds
Doses on Hand10


 
CVX Code83
MVX CodeSKB


Funding Source CodePHC70
Packaging10 pack – 1 dose syringe
Trade NameHAVRIX
Unit-of-Use (Vial/Syringe) Image

(01)10358160825436(17)290927(10)IIPVAXN11
GTIN10358160825436

Post-Condition

Data listed in the test cases listed below exist in the system under test.



Notes

This activity is not performed under proctor observation.

If unable to enter expired vaccination product please alert the proctor.

This was an attestation item-previously attested to.


Jurisdictions will individually determine if the Unit of Use or Unit of Sale NDC will be used when submitting vaccines to their IIS. This plan uses the Unit of Use NDC.


2.4. 2.4.0 - Configure system to meet local IIS reporting requirements

Test Story

Description

See test step for details.



Evaluation Criteria

See test step for details. 


2.4.1. 2.4.1 Add new vaccine program eligibility codes (e.g., VFC/317 vaccine programs). Supports test steps under function 7.0.0

Test Step Type: SUT_MANUAL

Test Story

Description

The SUT shall be required to capture the respective vaccine program applicable to the vaccine administered.

Various jurisdictions are establishing new programs to provide vaccines and their administration to defined patient populations for some or all vaccines.  Many are jurisdiction-specific programs.  

For context, the Immunization standard 2.5.1 uses OBX-5 to specify the client's eligibility for a funding program and the dose administered level. Table 0064 lists available codes as V01 Not VFC eligible, V02 VFC eligible-Medicaid/Medicaid Managed Care, V03 VFC eligible Uninsured, V04 VFC eligible American Indian/Alaskan Native, VFC eligible-Federally Qualified Health Center (underinsured), V07 Local-specific eligibility. The extension of the Financial Class code set supports local vaccine program eligibility - IIP024- Emergent Tick Borne Illness Vaccine Program



Comments

Supports steps 7.1.1, 7.1.2, 7.1.4 and 7.1.5



Pre-condition

No existing inventory codes contain a financial class of IIP024



Post-Condition

The entered vaccine includes a reference to the specific program that represents HL7 financial class IIP0024

Go to step 3.1.1


Test Objectives

To test the ability that the SUT can manage new program eligibility codes as they become available


Add Jurisdiction-Specific Vaccine Eligibility Code: The SUT demonstrates the ability to manage/add new program eligibility codes as they become available and to configure dose-level vaccine eligibility codes per jurisdictional requirements.



Evaluation Criteria

Financial class-specific eligibility program IIP024 exists post-entry:

1. Local user adds vaccine program to SUT

OR

2. SUT vendor enters vaccine program for users

CodeLabel/Description
IIP024HeartlandVV-Program


If a new vaccine program cannot be added dynamically, it should be added via the process originally attested to prior to the day of testing.
Previously Attested to: (a) Process for adding new program, (b) time it takes to add new program


3. 3.0.0 - Capability: Care Provision and Documentation

Test Story

Description

This "test group" includes basic functionality that allows SUT users to prepare, administer, and record care provision. Advanced functionality is excluded from this capability.



Notes

Advanced functionality excluded from the  "Care Provision and Documentation" capability includes: query, response, and reconciliation; display IIS immunization forecast; system configuration; display immunization forecast, transmission and acknowledgment; display immunization history; basic data quality; patient access; configuration; and transport.



3.1. LGD 3.1.0 - Select patient

Test Story

Description

See test step for details.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

Go to step 3.1.1


3.1.1. 3.1.1 Select patient

Test Step Type: SUT_MANUAL

Test Story

Description

Requirement: The SUT allows a practitioner to query and then select a patient's local medical record to perform subsequent actions such as view or update information or initiate a query for information to an IIS.

The user selects Lance Gaige Duncan, Jr as the patient. See HIMSS IIP v11.0 Job Aid for patient DOB, Today (day of test) the patient is 0 years, 1 months, and 17 days old.


Pre-condition

Lance Gaige Duncan Jr. is registered in the SUT. Please use the HIMSS IIP Test Plan v11.0 Job Aid located here for all steps related to Lance Gaige Duncan.

Daniela Jennifer Wyatt is the practitioner.





Post-Condition

Lance Gaige Duncan Jr. is selected by a user as the active patient in the SUT.

Go to step 3.2.1


Test Objectives

That the SUT can select a patient from a list of active patients.



Evaluation Criteria

This is a non-evaluated test step that must be performed to support other associated steps.


The following patient is selected as the active patient:

Patient
NameLance Gaige Duncan Jr.
Medical record number1111
Age and date of birth (reference only, not entered):DOB: See HIMSS IIP Test Plan v11.0 Job Aid Today (day of test) the patient is 0 years, 1 months, and 17 days old
VFC EligibleVFC eligible - American Indian/Alaskan Native




3.2. LGD 3.2.0 - Enter patient-provided immunization-related information

Test Story

Description

See test step for details.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

Go to step 3.2.1


Evaluation Criteria

SUT product shall permit the entry of patient-provided immunization information and records its source within local medical record.



3.2.1. 3.2.1 - Enter patient-provided immunization-related information

Test Step Type: SUT_MANUAL

Test Story

Description

Lance Gaige Duncan Jr.'s mother, Ingrid Stacy Duncan, brings a paper copy of the patient's birth hospital vaccine record to Oregon Family Medicine. This includes a birth dose of hepatitis B.

The hospital record does not indicate which hepatitis B vaccine product, therefore, the practitioner entering the vaccine in the patient's record uses CVX code 45 hepatitis B vaccine, unspecified formulation. This CVX code allows reporting of a vaccination when formulation is unknown (for example, when recording a HepB vaccination when noted on a vaccination card).


Pre-condition

Lance Gaige Duncan Jr. is registered in the SUT.

Lance Gaige Duncan Jr. is selected by a user as the active patient in the SUT.

Lance Gaige Duncan Jr.'s hospital paper medical record reflects a dose of hepatitis B was received on (see HIMSS IIP Test Plan v11.0 Job Aid for DOB/Administration Date)


Daniela Jennifer Wyatt is the practitioner.




Post-Condition

Lance Gaige Duncan Jr.'s SUT record reflects a dose of hepatitis B was received on (Please use the job aid located hereHIMSS IIP Test Plan v11.0 Job Aid). This dose is noted/labeled as 'historical'.

Go to step 5.4.1 to transmit the historical dose from this step.




Test Objectives

The SUT must enable entry of an immunization provided elsewhere, i.e., not administered by the practice running the software.

The software must be able to allow a practitioner to directly enter information about an immunization reported by a patient with minimum data requirements including:

(1) name of immunization product

(2) date of immunization (may be at specificity of year; month; and day)

(3) source of information (e.g. from IIS, from another practitioner)

Additionally, the software must store the source data captured and assure it is displayed in the immunization history indicating provenance (the data elements required). The proctor may accept display with an indicator which provides a mouse-over or a hyperlink for users to view all of the provenance details.


Evaluation Criteria

SUT product shall Permit the entry of patient-provided immunization information and records its source within local medical record.

Entered byDaniela Jennifer Wyatt
Entering organizationOregon Family Medicine
Vaccine producthepatitis B vaccine, unspecified formulation
Administered onPlease use the HIMSS IIP Test Plan v11.0 Job Aid
DOB=
Administration Date
Vaccine record sourceHistorical information - from other provider(see notes)

Notes

User Interface (UI) may only show vaccine product as "hepatitis B vaccine, unspecified formulation" - If the UI does not include the CVX code, the SUT must show how the display is linked to the underlying CVX code 45

Vaccine source must be recorded as "Historical information - from other provider" or a similar local version. This must differ from a historical doses from an unspecified source. In subsequent test steps, RXA-9 SHALL be populated as "02^Historical information - from other provider" no other codes will be accepted.

The hospital paper medical record does not include: the ordering practitioner, administered at facility, administering practitioner, the administered amount, administered units, the vaccine tradename, the vaccine manufacturer, the dose expiration date, the dose lot number, or vaccine route and site. Therefore, these data are not entered into the SUT.



3.3. LGD 3.3.0 - Display patient's updated immunization history

Test Story

Description

See test step for details.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

Go to step 3.3.1


Evaluation Criteria

See test step for details.



3.3.1. 3.3.1 - Display patient's updated immunization history

Test Step Type: SUT_MANUAL

Test Story

Description

Lance Gaige Duncan Jr.'s  SUT medical record now includes a hepatitis B vaccine dose record provided by a parent with minimum data.



Pre-condition

Lance Gaige Duncan Jr.'s SUT record reflects a dose of hepatitis B was received on (Please use the HIMSS IIP Test Plan v11.0 job aid). This dose is noted/labeled as 'historical'.


Daniela Jennifer Wyatt is the practitioner.






Post-Condition

Lance Gaige Duncan historical dose has been entered in the SUT and is visible to users.

Go to step 3.4.1


Test Objectives

To test the capability that the SUT is able to display updated immunization history.



Evaluation Criteria

Lance Gaige Duncan Jr.'s SUT medical record reflects the following minimum data:

Vaccine producthepatitis B vaccine, unspecified formulation
Administered onPlease use the  job aid located here: HIMSS IIP Test Plan v11.0 Job Aid
Vaccine record sourceHistorical information - from other provider (see notes)

Notes

Vaccine source must be recorded as "Historical information - from other provider" or a similar local version. This must differ from a historical doses from an unspecified source. In subsequent test steps, RXA-9 SHALL be populated as "02^Historical information - from other provider" no other codes will be accepted.



3.4. LGD 3.4.0 - Display patient's immunization local system (non-IIS) forecast

Test Story

Description

See test step for details.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

Go to step 3.4.1


Evaluation Criteria

See test step for details.



3.4.1. 3.4.1 - Display patient's immunization forecast

Test Step Type: SUT_MANUAL

Test Story

Description

The SUT is able to Display a single patient's immunization forecast report which may be (1) from the IIS - forecast with history of vaccinations this patient has received or (2) display immunization forecast created after reconciliation of IIS data with local data, or (3) in the absence of a new forecast, display the forecast obtained from the IIS (i.e., must display a forecast which SHALL be post-reconciliation if any changes have been made, or the original IIS forecast received if no reconciliation has occurred. 


Pre-condition

Two pre-conditions exist:
1.) Lance Gaige Duncan Jr. is registered in the SUT.
2.) Lance Gaige Duncan historical dose has been entered in the SUT and is visible to users.


Daniela Jennifer Wyatt is the practitioner.



Post-Condition

Updated forecast is available in SUT

Go to step 3.5.1


Test Objectives

To test the capability that the SUT is able to display forecast after immunization record updated.



Evaluation Criteria

At a minimum, the patient's forecast shall contain the dates for which the next childhood vaccine dose(s) are due:

Vaccine forecast for: Lance Gaige Duncan Jr.
DOB: Please use the  job aid located here: HIMSS IIP Test Plan v11.0 Job Aid
Age as of today: Today (day of test) the patient is 0 years, 1 months, and 17 days old


Please use the job aid for forecast dates

Earliest

Recommended
Past Due (not evaluated)
COVID



DTaP, Tdap or Td    



HepA                



HepB                



Hib                  



Influenza            



MMR                  



Pneumococcal        



Polio                



Rotavirus            



Varicella            






Notes

RSV is not included in this test plan forecast but may be included in your results-not evaluated.

For proctor: We expect to see a recommended date. If other dates are shown they are not to be evaluated. Take a screen shot of this forecast to compare the forecast generated in 3.9.1.

For this patient who is on schedule, the recommended age is used rather than recommended spacing.

"Recommended" is the date at which the next target dose should be given.

Other vaccines besides those listed above are not to be evaluated.



3.5. LGD 3.5.0 - Enter vaccination order

Test Story

Description

The SUT supports the ability to enter vaccine orders.



Pre-condition

Dr. Ramon Michael Bradshaw is the practitioner.


Post-Condition

Go to step 3.5.1


3.5.1. 3.5.1 - Enter vaccination order

Test Step Type: SUT_MANUAL

Test Story

Description

Allow practitioners to order the administration of immunizations to a patient using filters for type of vaccine, including combination vaccines.

Dr. Ramon Michael Bradshaw, orders the four vaccines to be administered to Lance Gaige Duncan Jr.:

PEDIARIX, CVX 110
ActHIB, CVX 48
Rotarix, CVX 119
Prevnar 20, CVX 216

Pre-condition

The patient Lance Gaige Duncan Jr.is registered in the SUT.

Lance Gaige Duncan Jr. has been selected as the active patient in the SUT.

Dr. Ramon Michael Bradshaw is the ordering practitioner.

Daniela Jennifer Wyatt is the entering practitioner for the order.



Post-Condition

An administering practitioner is able to select the same patient selected by Dr. Ramon Michael Bradshaw, the ordering provider, and the patient may now be administered doses of all vaccines ordered.

Go to step 3.6.1


Test Objectives

To test the capability that the SUT allows the order of immunizations for a patient using filters for vaccine types, including combination vaccines.



Evaluation Criteria

Dr. Ramon Michael Bradshaw intends to look for vaccines containing hepatitis B antigen.

The SUT will allow filtering as shown and the SUT user will enter the orders for the products listed as “The vaccine to be ordered”

Each order may be processed individually, or each selected to create an order set that allows entry of all orders together.

The SUT displays the following list of vaccines containing hepatitis B antigen:

Product Name (This may vary with each implementation)PEDIARIX 
Generic Name (CVX 110)DTaP-Hep B-IPV
CVX Code110


Product Name (This may vary with each implementation)RECOMBIVAX HB
Generic Name (CVX 08)Hep B, adolescent or pediatric
CVX Code08


Product Name (This may vary with each implementation)ENGERIX-B 
Generic Name (CVX 43)Hep B, adult
CVX Code43


Product Name (This may vary with each implementation)ENGERIX-B 
Generic Name (CVX 08)Hep B, adolescent or pediatric
CVX Code08


From the above list of vaccines containing hepatitis B antigen Item 1, PEDIARIX, CVX 110 is ordered.


Dr. Ramon Michael Bradshaw uses the information below to order(s) for the patient's first vaccine:

Product Name (This may vary with each implementation)PEDIARIX
Generic Name (CVX 110)DTaP-Hep B-IPV
CVX Code110


Next, Dr. Ramon Michael Bradshaw intends to look for vaccines containing Hib antigen.
The SUT displays the following vaccine containing Hib antigen:

Product Name (This may vary with each implementation)ActHIB 
Generic Name (CVX 48)Hib (PRP-T)
CVX Code48

From the above vaccine containing Hib antigen, ActHIB, CVX 48 is ordered.

Dr. Ramon Michael Bradshaw uses the information above to record order(s) for the patient's second vaccine.


Next, Dr. Ramon Michael Bradshaw intends to look for vaccines containing rotavirus antigen.
The SUT displays the following vaccine containing rotavirus antigen:

Product Name (This may vary with each implementation)Rotarix 
Generic Name (CVX 119)rotavirus, monovalent
CVX Code119

From the above containing rotavirus antigen, Rotarix CVX 119 is ordered.

Dr. Ramon Michael Bradshaw uses the information above to record order(s) for the patient's third vaccine.


Next, Dr. Ramon Michael Bradshaw intends to look for vaccines containing Pneumococcal conjugate antigen.
The SUT displays the following vaccine containing Pneumococcal conjugate antigen:

Product Name (This may vary with each implementation)Prevnar 20 
Generic Name (CVX 216)Pneumococcal conjugate PCV20, polysaccharide CRM197 conjugate, adjuvant, PF
CVX Code216

From the above containing Pneumococcal conjugate antigen, Prevnar 20 CVX 216 is ordered.


Dr. Ramon Michael Bradshaw uses the information above to record order(s) for the patient's fourth vaccine.

Patient
NameLance Gaige Duncan Jr.
DOBSee Job Aid
SUT Users 
Ordering ProviderRamon Michael Bradshaw
Entering OrganizationOregon Family Medicine
Order Entered ByDaniela Jennifer Wyatt


The proctor may accept one of the following presentations as acceptable for this test step:
(a) The SUT presents a list of all immunizations and provides the user with ability to filter by antigen and the sorted display includes single antigen and combination vaccines containing that antigen. The user selects each of the four vaccines indicated and orders each either as individual steps for each or a single step ordering all four.
(b) The SUT allows selection of each of the four immunizations in the test step directly from an immunization schedule, opening the ordering screen for each as it is selected and displaying only the vaccines containing the respective antigen(s).



Notes

Coded values are not expected to be displayed to the user, but it is expected that the value displayed to the user has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions.

Depending on the SUT's configuration, four separate orders may need to be placed, one for each vaccine dose.

In later tests it is expected vaccine products NDCs will appear in RXA segments and the ordering and entering practitioners will appear in a single ORC segment.



3.6. LGD 3.6.0 - Scan 2D barcodes found on vaccine vials and syringes to input the vaccine information

Test Story

Description

The SUT supports the ability to perform immunization data entry by scanning 2D barcodes found on vaccine vials and syringes: vaccine type and manufacturer (found within the NDC which is encoded in the GTIN), expiration date, and lot number.




Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

Go to step 3.6.1


Test Objectives

See test case for details



Evaluation Criteria

See test case for details



Notes

This may be performed concurrently as the function "Record vaccine administration".



3.6.1. 3.6.1 - Scan 2D barcodes found on vaccine vials and syringes to input the vaccine information

Test Step Type: SUT_MANUAL

Test Story

Description

The SUT supports the ability to perform immunization data entry by scanning 2D barcodes found on vaccine vials and syringes: vaccine type and manufacturer (found within the NDC which is encoded in the GTIN), expiration date, and lot number.


Based upon the orders of Dr. Ramon Michael Bradshaw, Nurse Daniela Jennifer Wyatt prepares to administer and record vaccines for Lance Gaige Duncan Jr. The following vaccines will be administered AND have 2D barcodes printed upon their vials/syringes: PEDIARIX, Rotarix, and ActHIB. These 2D barcodes are to be scanned to record vaccine type, lot number, and expiration date.



Pre-condition

Dr. Ramon Michael Bradshaw, orders the four vaccines to be administered to Lance Gaige Duncan Jr., however only the 3 listed below are scannable. 1 barcode is not scannable for Prevnar 20 and will be manually entered.

PEDIARIX, CVX 110
ActHIB, CVX 48
Rotarix, CVX 119


The above vaccine products exist in the SUT's inventory.
The SUT is connected to or may access a peripheral (e.g., handheld scanner or camera) that support scanning 2D barcodes printed on vials/syringes.


Daniela Jennifer Wyatt is the administering practitioner.


Post-Condition

Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users.

Go to step 3.7.1


Test Objectives

To test the capability that the SUT is able to scan 2D barcodes for vaccine administrations.



Evaluation Criteria

Lance Gaige Duncan Jr. has been administered vaccines by Nurse Daniela Jennifer Wyatt and the following information is entered into the patient record and visible in the SUT:

The 2D Barcode provided information in the following fields should be correct and without omission.

Item 1
Product Name (This may vary with each implementation)PEDIARIX
Date AdministeredToday's date
Unit-of-Use (Syringe or Vial) NDC58160-0811-43
(for reference only, please scan 2D barcode)
ManufacturerGlaxoSmithKline
(for reference only, please scan 2D barcode)
Lot NumberIIPVAXN01
(for reference only, please scan 2D barcode)
Expiration Date09/27/2029
(for reference only, please scan 2D barcode)
Dose0.5mL
Unit-of-Use (Vial/Syringe) Image that shall be scanned.GTIN 10358160811439
CVX110
Dose-level Eligibility for Vaccines for ChildrenAmerican Indian or Alaska Native
RouteINTRAMUSCULAR
SiteLeft Vastus Lateralis
VIS GivenMulti Pediatric Vaccines VIS - 07/24/2023


Item 2
Product Name (This may vary with each implementation)ActHIB
Date AdministeredPlease use the HIMSS IIP job aid
Unit-of-Use (Syringe or Vial) NDC49281-0547-58
Manufacturersanofi pasteur
Lot NumberIIPVAXN05
Expiration Date9/27/2029
Dose0.5mL
Unit-of-Use (Vial/Syringe) Image that may be scanned. GTIN 00349281547584

CVX48
Dose-level Eligibility for Vaccines for ChildrenAmerican Indian or Alaska Native
RouteINTRAMUSCULAR
SiteRight Vastus Lateralis
VIS GivenHaemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021


Item 3
Product Name (This may vary with each implementation)Rotarix
Date AdministeredToday's date
Unit-of-Use (Syringe or Vial) NDC58160-0740-02
ManufacturerGlaxoSmithKline
Lot NumberIIPVAXN07
Expiration Date9/27/2029
Dose1mL
Unit-of-Use (Vial/Syringe) Image that may be scanned. GTIN 10358160740029
CVX 119
Dose-level Eligibility for Vaccines for ChildrenAmerican Indian or Alaska Native
RouteORAL
SiteN/A
VIS GivenRotavirus Vaccine VIS - 10/15/2021

Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html



3.7. LGD 3.7.0 - Record vaccine administration via manual entry (not scanned)

Test Story

Description

The SUT supports the ability to perform immunization data entry by hand keying in vaccine details found vials and syringes: vaccine type and manufacturer (found within the NDC which is encoded in the GTIN), expiration date, and lot number.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

Go to step 3.7.1


Test Objectives

See test case for details



Evaluation Criteria

See test case for details



Notes

This may be performed concurrently as the function "Scan 2D barcodes found on vaccine vials and syringes to input the vaccine information"



3.7.1. 3.7.1 - Record vaccine administration via manual entry (not scanned)

Test Step Type: SUT_MANUAL

Test Story

Description

The SUT supports the ability to perform immunization data entry by hand keying in vaccine details found vials and syringes: vaccine type and manufacturer (found within the NDC which is encoded in the GTIN), expiration date, and lot number.

Based upon the orders of Dr. Ramon Michael Bradshaw, Nurse Daniela Jennifer Wyatt prepares to administer and record a dose of Prevnar 20 00005-2000-01, lot number LLBUAYMO6 for Lance Gaige Duncan Jr. However, the 2D barcode printed upon its vial/syringe is smudged and will not scan. Vaccine type, lot number, and expiration date are to be entered without a barcode scanner.



Pre-condition

Dr. Ramon Michael Bradshaw, orders the four vaccines to be administered to Lance Gaige Duncan Jr., however 1 barcode is not scannable for Prevnar 20 and will be manually entered.

Prevnar 20, CVX 216

Daniela Jennifer Wyatt is the administering practitioner.


Post-Condition

Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users.

Go to step 5.1.1 to transmit vaccines from step 3.6.1 and 3.7.1


Test Objectives

To test the ability that the SUT allows for manual entry of data from vaccine UoU.



Evaluation Criteria

Lance Gaige Duncan Jr. has been administered vaccines by Nurse Daniela Jennifer Wyatt and the following information is entered into the patient record and visible in the SUT:

Item 1
Product Name (This may vary with each implementation)Prevnar 20 00005-2000-01
Date AdministeredToday's date
Unit-of-Use (Syringe or Vial) NDC00005-2000-01
ManufacturerPfizer, Inc
Lot NumberLLBUAYMO6 (practitioner accidently enters as LLBUAYMO68 which will later be corrected and resubmitted in step 5.3.1
Expiration Date9/27/2029
Unit-of-Use (Vial/Syringe) Image that shall not be scanned.Purposely not provided here, please input manually.
Dose-level Eligibility for Vaccines for ChildrenAmerican Indian or Alaska Native
RouteINTRAMUSCULAR
SiteLeft Deltoid
VIS GivenPneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023
Dose:0.5mL
Generic Name (CVX 216)Pneumococcal conjugate PCV20, polysaccharide CRM197 conjugate, adjuvant, PF

Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html



3.8. LGD 3.8.0 - Print immunization record

Test Story

Description

The SUT produces a printable version a patient's immunization record that can be provided to a patient or caregiver.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.

Three pre-conditions have been met:

1) Lance Gaige Duncan historical dose has been entered in the SUT and is visible to users.

2) Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users.

3) Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users.



Post-Condition

Go to step 3.8.1


Evaluation Criteria

See test step for details.



3.8.1. 3.8.1 - Print immunization record

Test Step Type: SUT_MANUAL

Test Story

Description

Produces a printable version a patient's immunization record that can be provided to a patient or caregiver.


At the end of the visit for Lance Gaige Duncan Jr. mother, Ingrid Stacy Duncan requests a printed immunization record she can provide to her childcare provider as proof of Lance Gaige Duncan Jr. in-progress vaccine status.



Pre-condition

Three pre-conditions have been met:

1) Lance Gaige Duncan historical dose has been entered in the SUT and is visible to users.

2) Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users.

3) Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users.


Daniela Jennifer Wyatt is the practitioner.



Post-Condition

Ingrid Stacy Duncan is provided a printed copy of the immunization record for Lance Gaige Duncan Jr.

Go to step 3.9.1


Test Objectives

To test the capability that The SUT produces a printable version a patient's immunization record that can be provided to a patient or caregiver.



Evaluation Criteria

The printed vaccination record includes the following minimum elements: See HIMSS IIP Modular Testing Job Aid for dates

Patient Information:
NameLance Gaige Duncan Jr.
Date of birthPlease use the job aid 
Today (day of test) the patient is 0 years, 1 months, and 17 days old


Vaccine AntigensAdministration Date
DTaP / Diphtheria, Tetanus & Pertussis 
Dose 1Today's date


Hepatitis B
Dose 1DOB from Job Aid
Dose 2Today's date


Hib / Haemophilus influenzae type B 
Dose 1Today's date


Pneumococcal
Dose 1Today's date


Polio
Dose 1Today's date


Rotavirus
Dose 1Today's date

Notes

DTaP may be split out into its three components: Diphtheria, Tetanus & Pertussis.



3.9. LGD 3.9.0 - Display local immunization forecast (post administration)

Test Story

Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Evaluation Criteria

The SUT display a patient's local immunization forecast, updated after administration of vaccination doses.

Use the Job Aid Link below.

HIMSS IIP Test Plan v11.0 Job Aid


3.9.1. 3.9.1 - Display local immunization forecast (post administration)

Test Step Type: SUT_MANUAL

Test Story

Description

Display a patient's local immunization forecast, updated after administration of vaccination doses.



Pre-condition

Three pre-conditions exist: 

1)Lance Gaige Duncan Jr. is registered in the SUT.  

2)Lance Gaige Duncan historical dose has been entered in the SUT and is visible to users. 

3) Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

The pre-condition doses are visible in the SUT and the IIS.

Go to step 3.10.1


Test Objectives

To test the capability that the SUT is able to display a patient's local immunization forecast, updated after administration of vaccination doses.



Evaluation Criteria

This forecast for DTaP, hepatitis B, Hib, pneumococcal, and rotavirus vaccines shall differ from the forecast displayed before administration in test step 3.4.1

At a minimum, the patient's forecast shall contain the date(s) for which the next childhood vaccine dose(s) are due:

Vaccine forecast for: Lance Gaige Duncan Jr.
Today's Date: Please use the HIMSS IIP Test Plan v11.0 Job Aid
DOB: Today (day of test) the patient is 0 years, 1 months, and 17 days old

Childhood Vaccines:


Please use the job aid 
EarliestRecommendedPast Due (not evaluated)
COVID-19


DTaP, Tdap or Td     


HepA                 


HepB                 


Hib                  


Influenza            


MMR                  


Pneumococcal         


Polio                


Rotavirus            


Varicella            





Notes

RSV is not included in this test plan forecast but may be included in your results-not evaluated.



3.10. AJM 3.10.0 - Vaccine dose expiration is visually apparent to administering practitioner

Test Story

Description

SUT Informs the practitioner administering a vaccine if the dose chosen for administration is expired.



Evaluation Criteria

See test step for details.



3.10.1. 3.10.1 - Not evaluated: Select Patient

Test Step Type: SUT_MANUAL

Test Story

Description

Supports 3.10.3 - Informs administering practitioner that vaccine is expired


The user selects Alexandria Jacqueline Montoya (DOB 03/27/2012) as the active patient and opens her record in the SUT.




Pre-condition

Alexandria Jacqueline Montoya (DOB 03/27/2012) is registered in the SUT and has indicated No Consent given to share her data with IIS.


Dr. Ramon Michael Bradshaw is the ordering practitioner.

Daniela Jennifer Wyatt is the entering practitioner for the order.


Post-Condition

Alexandria Jacqueline Montoya is the active working patient in the SUT.

Go to step 3.10.2


Test Objectives

The SUT is able to select a patient for the purpose of entering an order.




Evaluation Criteria

This is a non-evaluated test step that must be performed to support other associated steps.

The following patient is selected as the active patient:

Patient
NameAlexandria Jacqueline Montoya
Medical record number2222
Age and date of birth (reference only, not entered):12 years old, DOB: 03/27/2012
VFC EligibleVFC eligible - Medicaid/Medicaid Managed Care
Protected? (Consent Indicator)Yes
IIS StatusActive

Notes

This step sets up the testing for notification of expired vaccine. No evaluation is required.


3.10.2. 3.10.2 - Not evaluated: Order vaccine

Test Step Type: SUT_MANUAL

Test Story

Description

Supports 3.10.3 - Informs administering practitioner that vaccine is expired


Dr. Ramon Michael Bradshaw, orders a dose of GARDASIL 9 (HPV9) for Alexandria Jacqueline Montoya (DOB: 03/27/2012). He is unaware of the current vaccine inventory, vaccine funding or patient vaccination program eligibility status.




Pre-condition

Dr. Ramon Michael Bradshaw is the ordering practitioner.

Daniela Jennifer Wyatt is the entering practitioner for the order.

Alexandria Jacqueline Montoya (DOB 03/27/2012) is registered in the SUT.
Alexandria Jacqueline Montoya is the active working patient in the SUT.
Two vaccine items have been entered into the SUT's inventory both for GARDASIL 9 (HPV 9), one is expired (Lot Number IIPVAXN09) and the other (Lot Number IIPVAXN08) is unexpired (i.e., still potent).



Post-Condition

The administering practitioner, Daniela Jennifer Wyatt is able to select Alexandria Jacqueline Montoya (DOB: 03/27/2012), the same patient selected by Dr. Ramon Michael Bradshaw, the ordering practitioner, and the patient, Alexandria Jacqueline Montoya (DOB: 03/27/2012) may now be administered a dose of HPV vaccine.

Go to step 3.10.3


Test Objectives

To test the ability of the SUT to order a vaccine from a selection of non-expired inventory.





Evaluation Criteria


This is a non-evaluated test step that must be performed to support other associated steps.


Notes

The following is not evaluated but must occur to evaluate additional SUT functionality in subsequent test steps:


Dr. Ramon Michael Bradshaw, orders a dose of GARDASIL 9 (HPV9) for Alexandria Jacqueline Montoya (DOB: 03/27/2012)

Patient
NameAlexandria Jacqueline Montoya
DOB03/27/2012
SUT Users 
Ordering ProviderRamon Michael Bradshaw
Entering OrganizationOregon Family Medicine
Order Entered ByDaniela Jennifer Wyatt


Product Name (This may vary with each implementation)GARDASIL 9
Generic Name (CVX 165)HPV9
CVX Code165

3.10.3. 3.10.3 - Make vaccine dose expiration date prominently available to user

Test Step Type: SUT_MANUAL

Test Story

Description

Administering Practitioner Daniela Jennifer Wyatt begins the process of fulfilling Dr. Ramon Michael Bradshaw vaccine order for Alexandria Montoya (DOB: 03/27/2012). Daniela Jennifer reviews the GARDASIL 9 - HPV9 inventory in the SUT.

Daniela Jennifer Wyatt notes two vaccine items are in the clinic's vaccine storage unit, both for GARDASIL 9 - HPV9, one is expired (Lot Number IIPVAXN09) and the other (Lot Number IIPVAXN08) is unexpired (i.e., still potent).



Pre-condition

(1) The patient, Alexandria Jacqueline Montoya (DOB 03/27/2012), is registered in the SUT.
(2) Two vaccine items have been entered into the SUT's inventory both for GARDASIL 9 - HPV9, one is expired (Lot Number IIPVAXN09) and the other (Lot Number IIPVAXN08) is unexpired (i.e., still potent).
(3) Dr. Bradshaw has ordered GARDASIL 9 - HPV9 for Alexandria Jacqueline Montoya (DOB 03/27/2012).
(4) Daniela Jennifer Wyatt, the administering practitioner, has opened the SUT's records for Alexandria Jacqueline Montoya (DOB 03/27/2012).



Post-Condition

The SUT makes the expired vaccine dose visually apparent from the unexpired doses to the administering practitioner or does not permit the administering practitioner from selecting an expired vaccine dose.

Go to step 3.11.1


Test Objectives

To test the capability that the SUT allows the administering practitioner to distinguish between expired and unexpired vaccine doses or prohibits the administering practitioner from selecting an expired vaccine dose.



Evaluation Criteria

While selection from a list would allow passive informing of expiration date, bar code scanning only allows active informing. “Active” informing means that the SUT either disallows the entry or allows the entry with information. If disallowed, the user by default must select a different product. If allowed, the user must delete the “incorrect” entry, and proceed to select the different product.

The SUT distinguishes the expired vaccine dose from the unexpired doses and is visually apparent to the administering practitioner. Alternatively, the SUT may prevent expired vaccine doses from being visible or selected by users.

The selection workflow includes clear evidence of a product expiration date in at least one of the following ways (only 1 method is required):

  • Passive: The vaccine product with expiration date before today not displayed by the SUT (i.e., cannot be chosen)
  • Passive: The display of selectable vaccine products has includes the expiration date and expiration dates before today are displayed with some indication that choosing that product is discouraged (e.g., hover over tooltip, color, bolding, graying out, or other UI indication used by the SUT for similar issues)
  • Active: Selection of a specific expired vaccine product to administer generates an informative messages in a method consistent with the SUT for similar issues) - Active informing



Notes

Alternatively, the SUT may meet the requirement by prohibiting the selection of an expired dose. However, careful consideration should be made when implementing such a strategy. A recent real-world example was the extension of emergency use authorization (EUA) vaccine product's expiration date by FDA. In systems where a product's expiration date is not able to able to be extended, users may need the option to administer vaccine product that the system believes to be expired.



3.11. AJM 3.11.0 - Patient vaccine program eligibility does not match vaccine funding

Test Story

Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Evaluation Criteria

See test step for details.



3.11.1. 3.11.1 - Inform administering user that the patient's vaccine program eligibility does not match vaccine funding source

Test Step Type: SUT_MANUAL

Test Story

Description

Administering Practitioner Daniela Jennifer Wyatt continues the process of fulfilling Dr. Ramon Michael Bradshaw's vaccine order for Alexandria Montoya (DOB: 03/27/2012).


Daniela Jennifer Wyatt recalls there was only one potent (i.e., not expired) GARDASIL 9 - HPV9 product in the vaccine storage unit (Lot Number IIPVAXN08).


Daniela Jennifer Wyatt notes that lot number IIPVAXN08 for GARDASIL 9 - HPV9 was paid for using Private funds which conflicts with the vaccine program eligibility for Alexandria Montoya (DOB: 03/27/2012), VFC eligible - Medicaid/Medicaid Managed Care


After determining infrequent replenishment is allowed by the State VFC Program and to ensure the patient begins the HPV9 series, Daniela Jennifer Wyatt decides to use lot number IIPVAXN08 for today's visit and replace the privately funded vaccine after the next VFC vaccine order is received.



Pre-condition

(1) The patient, Alexandria Jacqueline Montoya (DOB 03/27/2012), is registered in the SUT.

(2) Two vaccine items are stored in the clinic's vaccine storage unit, both for GARDASIL 9 (HPV 9), one is publicly funded and expired (Lot Number IIPVAXN09) and the other (Lot Number IIPVAXN08) is privately funded and unexpired (i.e., still potent).

(3) Dr. Bradshaw has ordered an HPV9 vaccine for Alexandria Jacqueline Montoya (DOB 03/27/2012). in step 3.10.2

(4) Daniela Jennifer Wyatt, the administering practitioner, has opened the SUT's records for Alexandria Jacqueline Montoya (DOB 03/27/2012).

(5) Infrequent replenishment is allowed by the State VFC Program.



Post-Condition

The SUT makes the mismatch of the vaccine product's funding source and the patient's vaccine program eligibility visually apparent to the administering practitioner or does not permit the administering practitioner from selecting the mismatched vaccine.


Alexandria Jacqueline Montoya (DOB 03/27/2012) is vaccinated with GARDASIL 9 - HPV9 lot number IIPVAXN08, and this information is incorporated into the SUT.

Go to step 5.7.1 to transmit this vaccine administration.


Test Objectives

To test the capability that the SUT allows the administering practitioner be aware of a mismatch of the vaccine product's funding source and the patient's vaccine program eligibility.



Evaluation Criteria

The SUT distinguishes the publicly funded vaccine dose from the privately funded doses and is visually apparent to the administering practitioner. Alternatively, the SUT may prevent publicly funded vaccine doses from being visible or selected by users.

The selection workflow includes clear evidence of a vaccine funding source in at least one of the following ways (only 1 method is required):

  • Passive: The vaccine product that is privately funded is not displayed by the SUT (i.e., cannot be chosen)
  • Passive: The display of selectable vaccine products which includes the funding source are displayed with some indication that choosing the wrong funding sourced product is discouraged (e.g., hover over tooltip, color, bolding, graying out, or other UI indication used by the SUT for similar issues)
  • Active: Selection of a specific privately funded vaccine product to administer generates informative messages in a method consistent with the SUT for similar issues) - Active informing

The SUT makes the mismatch of the vaccine product's funding source and the patient's vaccine program eligibility visually apparent to the administering practitioner or does not permit the administering practitioner from selecting the mismatched vaccine.

Vaccine Funding SourcePrivate funds
Patient Dose-level Eligibility for Vaccines for ChildrenVFC eligible - Medicaid/Medicaid Managed Care


The SUT may meet the requirement by prohibiting the selection of mismatch. However, careful consideration should be made when implementing such a strategy. This may result in patients not being immunized in a timely manner.

The following information is a not evaluated portion of this test step but supports subsequent test steps and should be performed by the SUT user:

Alexandria Jacqueline Montoya (DOB 03/27/2012) is administered vaccines by Nurse Daniela Jennifer Wyatt who enters the following information into the SUT:

Product Name (This may vary with each implementation)GARDASIL 9 00006-4121-01
Date AdministeredToday's Date
Unit-of-Use (Syringe or Vial) NDC00006-4121-01
ManufacturerMerck and Co., Inc.
Lot NumberIIPVAXN08
Expiration Date09/27/2029


Unit-of-Use (Vial/Syringe) Image that may be scanned.

GTIN 00300064121018
Patient Dose-level Eligibility for Vaccines for ChildrenVFC eligible - Medicaid/Medicaid Managed Care
Vaccine Funding SourcePrivate funds
RouteINTRAMUSCULAR
SiteLeft Deltoid
VIS GivenHPV (Human Papillomavirus) Vaccine VIS - 08/06/2021
CVX165
MVXMSD


Funding Source CodePHC70
Packaging10 pack – 1 dose syringe
Trade NameGARDASIL 9
Generic Name (CVX 165)HPV9

Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html





3.12. SNM 3.12.0 - Record adverse events

Test Story

Description

Nurse Daniela Wyatt receives a secure message that indicates one of the clinic's patients was recently seen by an associated hospital emergency department due to an adverse reaction associated with a vaccine dose administered outside the patient's medical home.


On 12/22/2023 Selma Nadia McKay (DOB 02/05/2023) is vaccinated against Hepatitis A outside of her medical home (Oregon Family Medicine).


After receiving the vaccine, Selma experiences an anaphylactic reaction and paramedics transfer her to a hospital emergency department. She recovers and is discharged home.


Selma’s mother follows up with Selma’s primary care provider, providing the outside clinic vaccination record and the Emergency Department (ED) discharge documentation.  The SUT user records this historical vaccination in the SUT (during preload).



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Test Objectives

See test step for additional details.



Evaluation Criteria

See test step for additional details.



Notes

In scope: Enables local capture of structured data regarding vaccine-related adverse events. 

Not in scope: Transmission of adverse event data to the IIS is out of scope due to immaturity of standards and inconsistent willingness of IIS to receive information regarding adverse events. 

Not in scope: Reporting adverse events to the Vaccine Adverse Event Reporting System (VAERS) is considered out of scope as it addresses a unique workflow initiated at the time a practitioner identifies and records a potential vaccine-associated adverse event. Such occurrence may be within minutes to days after transmission of vaccine administration data to the IIS. Further, a consensus-based interoperability standard is not evident to require consistent interoperability method for VAERS reporting.


3.12.1. 3.12.1 Not evaluated: Select Patient

Test Step Type: SUT_MANUAL

Test Story

Description

Nurse Daniela Wyatt receives a secure message that indicates one of the clinic's patients was recently seen by an associated hospital emergency department due to an adverse reaction associated with a vaccine dose administered outside the patient's medical home.


On 12/22/2023 Selma Nadia McKay (DOB 02/05/2023) is vaccinated against Hepatitis A outside of her medical home (Oregon Family Medicine).


After receiving the vaccine, Selma experiences an anaphylactic reaction and paramedics transfer her to a hospital emergency department. She recovers and is discharged home.


Selma’s mother follows up with Selma’s primary care provider, providing the outside clinic vaccination record and the Emergency Department (ED) discharge documentation.  The SUT user records this historical vaccination in the SUT (during preload).


Supports 3.12.2 Enables local capture of structured data regarding adverse events.


The user selects Selma Nadia McKay (DOB 02/05/2023) as the patient and opens the patient's record in the SUT.





Comments

This step sets up the testing for recording historical vaccines and adverse events. No evaluation is required.



Pre-condition

Selma Nadia McKay (DOB 02/05/2023) is registered in the SUT; including information about her primary medical home Oregon Family Medicine

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

Selma Nadia McKay (DOB 02/05/2023) is the active working patient in the SUT.


Go to step 3.12.2


Test Objectives

The SUT is able to select a patient for the purpose of recording adverse event details in the patient's medical record.



Evaluation Criteria

This is a non-evaluated test step that must be performed to support other associated steps.

The following patient is selected as the active patient:

Patient
NameSelma Nadia McKay
Medical record number3333
Age and date of birth (reference only, not entered):1 years old, DOB: 02/05/2023
VFC EligibleNot VFC eligible



3.12.2. 3.12.2 - Enable local capture of structured data regarding adverse events

Test Step Type: SUT_MANUAL

Test Story

Description

Nurse Daniela Wyatt receives a secure message that indicates one of the clinic's patients was recently seen by an associated hospital emergency department due to an adverse reaction associated with a vaccine dose administered outside the patient's medical home.



Pre-condition

Selma Nadia McKay (DOB 02/05/2023) is registered in the SUT and one dose of Hep A ped/Adol has been recorded (in preload historical data.). Patient has received 1 of 2 doses.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

A user has recorded and saved the adverse event for Selma Nadia McKay (DOB 02/05/2023) associated with one dose of Hep A, ped/adol, 2 dose (CVX 83) vaccine as structured data in the SUT. Patient received 1 of 2 doses.

Go to step 3.13.1


Test Objectives

To test the capability that the SUT allows a user to record an adverse event with an established Vaccination Reaction and Adverse Event (IIS) code as structured data (not free text). See Note #1.

Due to the lack of maturity of standards and acceptance of adverse events, transmission to IIS is excluded from the IIP test plan.



Evaluation Criteria

The SUT interface allows the a user  to enter the minimum required data elements for recording an adverse event including causative agent, reaction date, adverse event (detail in "minimum required data elements")

Minimum Required Data Elements:

Presumed causative agentHep A, ped/adol, 2 dose (CVX 83)See Note #2
Reaction noted date12/22/2023See Note #3
Structured adverse eventAnaphylaxis (disorder) - 39579001 - SNOMED-CTSee Note #4


The proctor will save screenshots of the user interface showing the required information. If the UI does not includes the structured data (e.g., CVX code and/or SNOMED Code) the proctor will request SUT display and obtain a screenshot of the underlying terminology mapping.


Notes
#1 - The list of coded vaccination reactions may be found here: https://phinvads.cdc.gov/vads/ViewValueSet.action?id=635A4FEA-8232-E211-8ECF-001A4BE7FA90
#2 - Alternatively, the SUT's local equivalent may be used. The SUT's graphic user interface may display text that differs, however this must be bound to an underlying hepatitis A vaccine CVX code listed here: https://www2a.cdc.gov/vaccines/iis/iisstandards/vaccines.asp?rpt=cvx. Free text is NOT permitted.
#3 - The value for reaction noted date may vary from what is listed in the minimum required elements. It could be: the date reaction occurred, the date identified by a practitioner, or the date recorded in the SUT. Exact dates cannot be assured in data entry so any related date is acceptable.
#4 - Alternatively, the SUT's local equivalent may be used. The SUT's graphic user interface may display text that differs, however this must be bound to an underlying code in the Vaccination Reaction and Adverse Event (IIS) value set. For this specific tested reaction, free text is NOT permitted as anaphylaxis is included in the Vaccination Reaction and Adverse Event (IIS) value set.
#5 In the past IIP tested functionality that included reporting presumed vaccine-related adverse reactions to local public health authorities through data exchange with and IIS as well as reporting of presumed vaccine-related adverse reaction to CDC and FDA, US national public health authorities through a report to Vaccine Adverse Event Reporting System (VAERS). This functionality is considered out of scope and is therefore not tested in the current IIP test plan basic interoperability and data quality module. 
#6 In the IIP test case, the SUT is merely being used to record presumed adverse reactions in the local system. This functionality is required to enable subsequent workflow. The SUT should determine the location in the software where entry of the adverse event is appropriate (may vary by SUT - e.g., allergy list, immunization record)

3.13. SNM 3.13.0 - Inform ordering user of previous adverse event

Test Story

Description

See test step for details.



Pre-condition

Dr. Ramon Michael Bradshaw is the ordering practitioner.

Daniela Jennifer Wyatt is the entering practitioner for the order.


3.13.1. 3.13.1 - Inform users ordering vaccine (procedures) to previous adverse events for a specific patient

Test Step Type: SUT_MANUAL

Test Story

Description

A practitioner at Oregon Family Medicine views the vaccine schedule for Selma Nadia McKay (DOB 02/05/2023) and orders the vaccine to be administered to the patient.




Pre-condition

Selma Nadia McKay (DOB 02/05/2023) is registered in the SUT.


SUT includes an adverse event recorded for Selma Nadia McKay (DOB 02/05/2023) with causative agent = Hep A ped/adol, 2 dose (83) and reaction = anaphylaxis (SNOMED-CT 39579001) onset 03/22/2024.

Dr. Ramon Michael Bradshaw is the ordering practitioner.

Daniela Jennifer Wyatt is the entering practitioner for the order.


Post-Condition

The order for Hep A ped/adol has been entered and within the ordering process (during or post-entry) the SUT provides clear evidence of the prior reaction.

Go to step 3.13.2


Test Objectives

To test the capability that the SUT informs the user of the previous vaccine-related adverse reaction although the user overrides the information and enters the order (or the order generates an alert).



Evaluation Criteria

The ordering workflow includes clear evidence of a previous adverse reaction to Hepatitis A vaccine in at least one of the following ways (only 1 method is required):

  • The vaccine schedule displays evidence of a concern regarding the display for Hepatitis A vaccine
  • The display of orderable vaccines has an indication of a concern to address specific to the Hepatitis A vaccine options
  • Selection of a specific Hepatitis A vaccine to order includes indication of a concern to move forward with the order
  • Entry of the order for Hepatitis A vaccine results in a message indicating the previous adverse reaction
  • The user is able to proceed with entering / completing / saving the order, thus bypassing the information provided.

Notes

In scope: Expect evidence of prior adverse event to be present in the user interface (actively or passively) at the time of vaccine selection, ordering, or administration.

Not in scope: Transmission of prior adverse event data to the IIS

Order Details if needed:
Product Name (This may vary with each implementation)HAVRIX
Generic Name (CVX 83)Hep A, ped/adol, 2 dose
CVX Code83


SUT Users
Ordering ProviderRamon Michael Bradshaw
Entering OrganizationOregon Family Medicine
Order Entered BYDaniela Jennifer Wyatt


PatientSelma Nadia McKay
DOB1 years old, DOB: 02/05/2023




3.13.2. 3.13.2 - Inform users administering vaccine to previous adverse events for a specific patient

Test Step Type: SUT_MANUAL

Test Story

Description

A vaccine administering practitioner at Oregon Family Medicine attempts to administer Hepatitis A vaccine to Selma Nadia McKay (DOB 02/05/2023) based on the order previously entered.



Pre-condition

·      Selma Nadia McKay (DOB 02/05/2023) is registered in the SUT
·      SUT includes an adverse event recorded for Selma Nadia McKay (DOB 02/05/2023) with causative agent = Hep A ped/adol, 2 dose (83) and reaction = anaphylaxis (SNOMED-CT 39579001) onset 12/22/2023
·      Hep A vaccine order exists (i.e., has been placed)
·      SUT provides a list of available vaccine product to fulfill the order for Hepatitis A vaccine

Daniela Jennifer Wyatt is the administering practitioner.


Post-Condition

Selection for any Hep A ped/adol product provides evidence of the prior reaction and the administration is avoided.

Go to step 4.1.1


Test Objectives

To test the capability that the SUT informs the individual administering a vaccine that the patient had an adverse reaction this vaccine in the past. The method and timing of notification can be specified to meet local clinical workflow. This requirement is a “failsafe” mechanism in case the practitioner orders a vaccine dose that may be unsafe for the patient.



Evaluation Criteria

The practitioner prepares to administer the Hepatitis A vaccine, and system informs the practitioner that the patient had an adverse reaction in the past. Successful performance requires:

The administration workflow includes clear evidence of a previous adverse reaction to Hepatitis A vaccine in at least one of the following ways (only 1 method is required):

* The SUT provides a "task" for the administering practitioner. The "task" indicates an order exists to administer Hepatitis A vaccine to this patient and includes indication about a previous adverse reaction within the task message. The practitioner user then selects the option to choose a product to administer.

* The order, when opened, shows evidence that a warning about a previous adverse reaction has been overridden

* The available vaccine products display evidence of a concern regarding each of the Hepatitis A vaccine products

* Selection of a specific Hepatitis A vaccine to administer includes indication of a concern to move forward with the administration



3.14. DCM 3.14.0 - Record vaccine administration refusal by patient or caregiver

Test Story

Description

See test step for details.



Pre-condition

Dr. Ramon Michael Bradshaw is the ordering practitioner.

Daniela Jennifer Wyatt is the entering practitioner for the order.


3.14.1. 3.14.1 Not evaluated: Select Patient for refused vaccine

Test Step Type: SUT_MANUAL

Test Story

Description

Supports Test Step 3.15.3-During a well child exam, Dr. Ramon Bradshaw recommends that Deborah Charlotte McKay receive a hepatitis A vaccine. Deborah's mother, Angeline McKay, disagrees with Dr. Ramon Bradshaw's recommendation due to Deborah's twin Selma having a previous adverse reaction to the vaccine and wants to make her refusal clear that Deborah Charlotte McKay is not to receive the vaccine today or in the future.

The user selects Deborah Charlotte McKay (DOB 02/05/2023) as the patient and opens the patient's record in the SUT.


Pre-condition

Deborah Charlotte McKay (DOB 02/05/2023) is registered in the SUT.

Dr. Ramon Michael Bradshaw is the ordering practitioner.

Daniela Jennifer Wyatt is the entering practitioner for the order.


Post-Condition

Deborah Charlotte McKay (DOB 02/05/2023) is the active patient in the SUT.

Go to step 3.14.2


Test Objectives

The SUT selects a patient record to perform subsequent actions.



Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.


The following patient is selected as the active patient:

Patient
NameDeborah Charlotte McKay
Medical record number4444
Age and date of birth (reference only, not entered):1 years old, DOB: 02/05/2023
VFC EligibleNot VFC eligible

Notes

This is not an evaluated step to start the "Care Provision and Documentation" capability.



3.14.2. 3.14.2 Not evaluated : Practitioner enters order for Hep A vaccine that will later be refused

Test Step Type: SUT_MANUAL

Test Story

Description

Supports Test Step 3.15.3-During a well child exam, Dr. Ramon Bradshaw recommends that Deborah McKay receive a hepatitis A vaccine. Prior to the exam, Dr. Bradshaw reviews the patient's medical record and preps the record by entering the recommended vaccine orders in the encounter.



Pre-condition

Dr. Bradshaw has ordered a dose of hepatitis A vaccine and a dose of hepatitis B vaccine.

Daniela Jennifer Wyatt is the entering practitioner for the order.


Post-Condition

The Hep A order is visible to the administering practitioner.


The Hep B order is visible to the administering practitioner.

Go to step 3.14.3


Test Objectives

The SUT allows the order of a vaccine.



Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.



Notes

This is non evaluated step to the "Care Provision and Documentation" capability.


The following vaccine order is entered prior to the parent refusal:

Vaccine Order 1
Order Details
Product Name (This may vary with each implementation)HAVRIX
Generic Name (CVX 83)Hep A, ped/adol, 2 dose
CVX Code83


The following vaccine order is entered:

Vaccine order 2
Product Name (This may vary with each implementation)ENGERIX-B 58160-0820-43
Generic NameHep B, adolescent or pediatric
CVX Code08




Ordering ProviderRamon Michael Bradshaw
Entering OrganizationOregon Family Medicine
Order Entered BYDaniela Jennifer Wyatt


PatientDeborah Charlotte McKay
DOB1 years old, DOB: 02/05/2023

3.14.3. 3.14.3 - Not evaluated: Record vaccine administration that was refusal by patient or caregiver

Test Step Type: SUT_MANUAL

Test Story

Description

During a well child exam, Dr. Ramon Bradshaw recommends that Deborah Charlotte McKay receive a hepatitis A vaccine. Deborah's mother, Angeline McKay, disagrees with Dr. Ramon Bradshaw's recommendation and wants to make her refusal clear that Deborah Charlotte McKay is not to recieve the vaccine today or in the future.

Practitioner pre records the vaccine administration prior to giving the vaccine and patient's mother refusing. The vaccine is transmitted but later deleted (step 5.5.3) and refusal sent  (step 5.5.5).



Pre-condition

Deborah McKay exists in the SUT.

Daniela Jennifer Wyatt is the administering practitioner.


Post-Condition

The vaccine record is available to SUT users.

Go to step 5.5.1 to transmit the vaccine recorded in this step.


Test Objectives

This test step sets up future flow for transmission to the IIS supporting the ability to delete a record. It is not evaluated



Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.

User shall record the vaccine for hepatitis A in the SUT with the following data: 


Product Name (This may vary with each implementation)HAVRIX 58160-0825-43
Date AdministeredToday's date
Unit-of-Use (Syringe or Vial) NDC58160-0825-43



GTIN 10358160825436
Manufacturer NameGlaxoSmithKline
Lot NumberIIPVAXN11
Expiration Date09/27/2029
MVX (Manufacturer Code)SKB
CVX83
Patient Dose-level Eligibility for Vaccines for ChildrenNot VFC Eligible
Vaccine Funding SourcePrivate funds
RouteINTRAMUSCULAR
SiteLeft Vastus Lateralis
VIS GivenHepatitis A Vaccine VIS - 10/15/2021
Dose0.5mL
Generic Name (CVX)Hep A, ped/adol, 2 dose (CVX 83)

Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html



3.14.4. 3.14.4 - Record vaccine refusal by patient or caregiver

Test Step Type: SUT_MANUAL

Test Story

Description

During a well child exam, Dr. Ramon Bradshaw recommends that Deborah Charlotte McKay receive a hepatitis A vaccine. Deborah's mother, Angeline McKay, disagrees with Dr. Ramon Bradshaw's recommendation and wants to make her refusal clear that Deborah Charlotte McKay is not to receive the vaccine today or in the future.



Pre-condition

Deborah McKay exists in the SUT.

Daniela Jennifer Wyatt is the practitioner recording refusal.

The Hep B order is visible to the administering practitioner.



Post-Condition

The refusal record is available to SUT users.

The Hep B administration is visible to SUT users.

Go to step 5.6.1 to transmit refusal from this step.


Test Objectives

To test the capability that the SUT allows users to record vaccine administration refusal by a patient or caregiver.



Evaluation Criteria

The coded values are not expected to be displayed to the user, but it is expected that the value selected has the identified meaning, and it is expected that the system will use the coded value when the attribute is conveyed in later transactions.

Patient information:
FirstDeborah
MiddleCharlotte
LastMcKay
Date of Birth02/05/2023
Medical record number4444


Refusal Information:
Date of refusalToday's date
VaccineHep A, ped/adol, 2 dose (CVX 83)
ReasonParental decision (NIP002 00)


Refused by:
FirstAngeline
MiddleIngrid
LastMcKay
Relation to PatientMother


Vaccine 2 Administration -The 2D Barcode provided information in the following fields should be correct and without omission.
Product Name (This may vary with each implementation)ENGERIX-B 58160-0820-43
Date AdministeredToday's date
Unit-of-Use (Syringe or Vial) NDC58160-820-43
(for reference only, please scan 2D barcode)
ManufacturerGlaxoSmithKline (for reference only, please scan 2D barcode)
Lot NumberIIPVAXN04 (for reference only, please scan 2D barcode)
Expiration Date09/27/2029
(for reference only, please scan 2D barcode)
CVX 0808
Unit-of-Use (Vial/Syringe) Image that shall be scanned.
GTIN 10358160811439
Dose-level Eligibility for Vaccines for ChildrenNot VFC eligible
RouteINTRAMUSCULAR
SiteRight Vastus Lateralis
VIS GivenHepatitis B Vaccine VIS - 05/12/2023



Notes

User shall record the refusal for hepatitis A in the SUT with the following data: Substance/Treatment Refusal Reason: Parent Decision (NIP002 00);

The UI may not show the codes referenced but the SUT SHALL show there is underlying code to support transmission to the IIS as coded data with the RXA Completion status of Refused (RE)



3.15. 3.15.0 - Produce cohort reports

Test Story

Description

See test step for details.



3.15.1. 3.15.1 - Attestation: Cohort Report Requirements

Test Step Type: SUT_MANUAL

Test Story

Description

The SUT provides customers with the ability to list a cohort of patients who are (a) due for vaccines, (b) overdue for vaccines, and (c) recipients of specific vaccine lot numbers.



Test Objectives

The ability to create cohort reports based upon specific filtering parameters



Evaluation Criteria

This is a non-evaluated test step that must be performed to support other associated steps.


This was an attestation item-previously attested to.

Cohort reports:
1. All patients overdue for specific vaccines
a. SUT provides pre-configured report available to customers
b. Customers can create reports based on overdue status
c. Customers can request custom report from the vendor
2. All patients due for specific vaccines
a. SUT provides pre-configured report available to customers
b. Customers can create reports based on vaccine due status
c. Customers can request custom report from the vendor
3. All patients administered vaccines with specific lot numbers
a. SUT provides pre-configured report available to customers
b. Customers can create reports based on vaccine lot number administered
c. Customers can request custom report from the vendor

4. 4.0.0 - Capability: Query, Response, and Reconciliation

Test Story

Description

The SUT allows for the query of a patient's evaluated immunization history and vaccine forecast. SUT receives various responses to a query of a patient's evaluated immunization history and vaccine forecast from IIS. SUT allows for the reconciliation of immunization data received from IIS.



Post-Condition

A Z44 profile message (query) is generated and transmitted to the IIS and a Z42 response is returned.



Evaluation Criteria

See test steps for details



4.1. SNM 4.1.0 - Display Local Forecast

Test Story

Description

SUT Proctor takes a screenshot of the SUT's local forecast before performing query for evaluated history and forecast. This is to support Step 4.5.1 - re-evaluate patient's immunization forecast after reconciling IIS-provided vaccine history.

The user selects Deborah Charlotte McKay (DOB 02/05/2023) as the patient and opens the patient's record in the SUT.


Pre-condition

Existing patient's demographic data are stored within the SUT.

Selma Nadia McKay (DOB 02/05/2023), has the following vaccines recorded in the SUT: 1 dose of Hepatitis A and 1 dose of Hepatitis B and has the following vaccines recorded in the IIS: 3 doses of Hepatitis B, 3 doses of Rotavirus, 3 doses of DTaP, 4 doses of Hib, 4 doses of PCV20, 3 dose of IPV, 2 doses influenza, 2 MMR (1 invalid, 1 as MMRV-Varicella.)

The patient has the following vaccines recorded in the SUT: 1 dose of Hepatitis A and 1 dose of Hepatitis B.

Daniela Jennifer Wyatt is the practitioner.


Test Objectives

See test step



Evaluation Criteria

Not evaluated



Notes

The Rotavirus vaccine should not appear in the forecast for children older than 15 weeks who have not been immunized.

RSV is not included in this test plan forecast but may be included in your results-not evaluated.



4.1.1. 4.1.1 Pre-test step, display local forecast

Test Step Type: SUT_MANUAL

Test Story

Description

The SUT forecast for Selma Nadia McKay (DOB 02/05/2023) is being displayed. A patient's immunization history in the SUT is incomplete. A query for an immunization history and forecast to the IIS and processing a response have not yet been performed. The incomplete nature of the patient's immunization history also impacts the SUT's forecast. The SUT is likely recommending vaccine doses that have been administered yet are not known to the SUT. Since the SUT has not yet queried the IIS for the patients vaccination history, the local vaccination history is incomplete and the forecast is based upon the same incomplete information.



Pre-condition

Selma Nadia McKay (DOB 02/05/2023), has the following vaccines recorded in the SUT: 1 dose of Hepatitis A and 1 dose of Hepatitis B and has the following vaccines recorded in the IIS: 3 doses of Hepatitis B, 3 doses of Rotavirus, 3 doses of DTaP, 4 doses of Hib, 4 doses of PCV20, 3 dose of IPV, 2 doses influenza, 2 MMR (1 invalid, 1 as MMRV (Varicella.)

Daniela Jennifer Wyatt is the practitioner.



Post-Condition

The patient's vaccine forecast from the SUT is available to a practitioner.

Go to step 4.2.1


Test Objectives

The ability of the SUT to display an updated forecast post-reconciliation of the immunization history.



Evaluation Criteria

While the proctor is not evaluating the content of the forecast in this step, the proctor is asked to take a screenshot to compare this forecast with the future forecast in step 4.5.1. The screenshot should include the vaccines listed. This is to support Step 4.5.1 - re-evaluate patient's immunization forecast after reconciling IIS-provided vaccine history.

Due to the limited vaccination records within the SUT the following vaccines are provided to SUT users:

Vaccine
DTaP, Tdap or Td     
COVID
Hep A                 
Hep B
Influenza            
MMR                  
Polio                
Pneumococcal
Varicella            

Notes

The Rotavirus vaccine should not appear in the forecast for children older than 15 weeks who have not been immunized.

RSV is not included in this test plan forecast but may be included in your results-not evaluated.



4.2. SNM 4.2.0 - Query sent to the IIS

Test Story

Description

SUT Requests (query) a patient's evaluated immunization history and vaccine forecast from an IIS using an HL7 v2.5.1 Z44 profile message.



Pre-condition

Existing patient's demographic data are stored within the SUT.

Selma Nadia McKay (DOB 02/05/2023), has the following vaccines recorded in the SUT: 1 dose of Hepatitis A and 1 dose of Hepatitis B and has the following vaccines recorded in the IIS: 3 doses of Hepatitis B, 3 doses of Rotavirus, 3 doses of DTaP, 4 doses of Hib, 4 doses of PCV20, 3 dose of IPV, 2 doses influenza, 2 MMR (1 invalid, 1 as MMRV (Varicella.)


Daniela Jennifer Wyatt is the practitioner.


Notes

The Rotavirus vaccine should not appear in the forecast for children older than 15 weeks who have not been immunized.

RSV is not included in this test plan forecast but may be included in your results-not evaluated.



4.2.1. 4.2.1 - Requests (query) a patient's evaluated immunization history and vaccine forecast from an IIS

Test Step Type: SUT_INITIATOR

Test Story

Description

SUT shall Requests (query) a patient's evaluated immunization history and vaccine forecast from an IIS using an HL7 v2.5.1 Z44 profile message.

Nurse, Daniela Wyatt, uses SUT to lookup (query) Selma Nadia McKay evaluated immunization history and forecast.



Pre-condition

Selma Nadia McKay's demographic data are stored within the SUT.

Some of Selma Nadia McKay's immunization data from the IIS does not exist within the SUT.

Selma Nadia McKay's evaluated immunization history and forecast exists within the IIS.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

A query for Selma Nadia McKay's evaluated immunization history and forecast (profile Z44 message) has been sent from the SUT to the IIS.

Go to step 4.2.2 to receive and process RSP from this step


Test Objectives

To test the capability that the SUT is able to query patient immunization history and forecast from IIS.



Evaluation Criteria

SUT triggers Z-44 profile message (request for evaluated history and forecast) to the IIS that meets the following requirements:

The message's Query by Parameter (QDP) segment contains the following patient information:

Patient Information
ElementData
Patient NameSelma Nadia McKay
Mother's Maiden NameSchroeder
ID Number3333
Date/Time of Birth02/05/2023
Administrative SexFemale
Patient Address600 Cherry Rd. Springfield, OR 97477 USA
Phone Number(541) 555-1236 (Telephone=PH)
Multiple Birth IndicatorY
Birth Order1


- Limits the query response to one response (RCP-2.1 = 1)


Notes

The Rotavirus vaccine should not appear in the forecast for children older than 15 weeks who have not been immunized.

RSV is not included in this test plan forecast but may be included in your results-not evaluated.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405093021-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code QBP Value-Profile Fixed
MSH-9.2 Trigger Event Q11 Value-Profile Fixed
MSH-9.3 Message Structure QBP_Q11 Value-Profile Fixed
MSH-10 Message Control ID IIP411 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID OFM Presence-Configuration
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code XX Value-Profile Fixed
MSH-22.10 Organization Identifier 197028 Presence-Configuration
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIP Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID IIP Presence-Configuration
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code XX Value-Test Case Fixed
MSH-23.10 Organization Identifier 197027 Presence-Configuration

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44 Value-Test Case Fixed
QPD-1.2 Text Request Evaluated History and Forecast Value-Test Case Fixed
QPD-1.3 Name of Coding System CDCPHINVS Value-Test Case Fixed
QPD-1.4 Alternate Identifier
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IIPQUERY1 Presence-System Generated
QPD-3 Patient List
QPD-3.1 ID Number 3333 Value-Test Case Fixed
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID IIP-MPI-1 Value-Test Case Fixed
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR Value-Test Case Fixed
QPD-4 Patient Name
QPD-4.1 Family Name
QPD-4.1.1 Surname McKay Value-Test Case Fixed
QPD-4.2 Given Name Selma Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Nadia Presence-Content Indifferent
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 Patient Mother Maiden Name
QPD-5.1 Family Name
QPD-5.1.1 Surname Schroeder Value-Test Case Fixed
QPD-5.2 Given Name
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 Patient Date of Birth
QPD-6.1 Time 20230205 Presence-System Generated
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 600 Cherry Rd. Value-Test Case Fixed
QPD-8.2 Other Designation NonPresence
QPD-8.3 City Springfield Value-Test Case Fixed
QPD-8.4 State or Province OR Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 97477 Value-Test Case Fixed
QPD-8.6 Country USA Value-Test Case Fixed
QPD-8.7 Address Type P Value-Test Case Fixed
QPD-9 Patient Home Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 541 Value-Test Case Fixed
QPD-9.7 Local Number 5551236 Value-Test Case Fixed
QPD-10 Patient Multiple Birth Indicator Y Value-Test Case Fixed
QPD-11 Patient Birth Order 1 Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I Value-Test Case Fixed
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1 Value-Test Case Fixed
RCP-2.2 Units
RCP-2.2.1 Identifier RD Value-Test Case Fixed
RCP-2.2.2 Text Records Presence-Test Case Proper
RCP-2.2.3 Name of Coding System HL70126 Value-Profile Fixed
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Selma Nadia McKay
Mother's Maiden Name Schroeder
ID Number 3333
Date/Time of Birth 02/05/2023
Sex Female
Patient Address 600 Cherry Rd. Springfield OR 97477 USA
Patient Phone (541)555-1236
Birth Indicator Yes
Birth Order 1

4.2.2. 4.2.2 - Receive and process a patient's evaluated immunization history and vaccine forecast from an IIS

Test Step Type: TA_RESPONDER

Test Story

Description

After receiving a query for the patient's evaluated history and forecast, the IIS generates and sends a return evaluated history response (RSP -- Z42 profile) message to the SUT.



Pre-condition

A query for Selma Nadia McKay's evaluated immunization history and forecast (profile Z44 message) has been sent from the SUT to the IIS.

Selma Nadia McKay (DOB 02/05/2023), has the following vaccines recorded in the SUT: 1 dose of Hepatitis A and 1 dose of Hepatitis B and has the following vaccines recorded in the IIS: 3 doses of Hepatitis B, 3 doses of Rotavirus, 3 doses of DTaP, 4 doses of Hib, 4 doses of PCV20, 3 dose of IPV, 2 doses influenza, 2 MMR (1 invalid, 1 as MMRV (Varicella.)



Daniela Jennifer Wyatt is the practitioner.


Post-Condition

The patient's evaluated immunization history from the IIS is available to a clinician to compare with the SUT's records.

Go to step 4.3.1


Test Objectives

Confirms valid receipt and display of response message using the Juror Document.
To test the capability that the SUT is able to consume immunization history returned from IIS.



Evaluation Criteria

Confirm SUT's receipt of a return evaluated history (RSP -- Z42 Profile) message from an IIS that includes the following history details (IIS forecast does not need to be displayed). Validity must be present but validity reason may or may not be present and will not be evaluated.

AntigenDateVaccine Given (CVX)SourceValidity
DTaP, Tdap or Td     4/5/2023DTaP-Hib-IPV (120)Historical information - from public agencyValid
DTaP, Tdap or Td     6/5/2023DTaP-Hib-IPV (120)Historical information - from public agencyValid
DTaP, Tdap or Td     8/5/2023DTaP-Hib-IPV (120)Historical information - from public agencyValid
HepB02/05/2023Hep B, Adol/peds (08)Historical information - from public agencyValid
HepB3/5/2023Hep B, Adol/peds (08)Historical information - from public agencyValid
HepB8/5/2023Hep B, Adol/peds (08)Historical information - from public agencyValid
Hib4/5/2023DTaP-Hib-IPV (120)Historical information - from public agencyValid
Hib6/5/2023DTaP-Hib-IPV (120)Historical information - from public agencyValid
Hib8/5/2023DTaP-Hib-IPV (120)Historical information - from public agencyValid
Hib2/5/2024Hib PRP-OMP (149)Historical information - from public agencyValid
Influenza8/5/2023Influenza, injectable, quadrivalent (158)Historical information - from public agencyValid
Influenza9/2/2023Influenza, injectable, quadrivalent (158)Historical information - from public agencyValid
MMR2/5/2024MMRV (94)Historical information - from public agencyValid
MMR8/5/2023MMRHistorical information - from public agencyInvalid
Pneumococcal4/5/2023PCV20 (216)Historical information - from public agencyValid
Pneumococcal6/5/2023PCV20 (216)Historical information - from public agencyValid
Pneumococcal8/5/2023PCV20 (216)Historical information - from public agencyValid
Pneumococcal2/5/2024PCV20 (216)Historical information - from public agencyValid
Polio4/5/2023DTaP-Hib-IPV (120)Historical information - from public agencyValid
Polio6/5/2023DTaP-Hib-IPV (120)Historical information - from public agencyValid
Polio8/5/2023DTaP-Hib-IPV (120)Historical information - from public agencyValid
Rotavirus4/5/2023Rotavirus, pentavalent (116)Historical information - from public agencyValid
Rotavirus6/5/2023Rotavirus, pentavalent (116)Historical information - from public agencyValid
Rotavirus8/5/2023Rotavirus, pentavalent (116)Historical information - from public agencyValid
Varicella2/5/2024MMRV (94)Historical information - from public agencyValid



Notes

The Rotavirus vaccine should not appear in the forecast for children older than 15 weeks who have not been immunized.

RSV is not included in this test plan forecast but may be included in your results-not evaluated.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405093021-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID IIP-RSP-1
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIP
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID IIP411

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IIPQUERY1
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.4 Alternate Identifier
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.4 Alternate Identifier
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IIPQUERY1
QPD-3 Patient List
QPD-3.1 ID Number 3333
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID IIP-MPI-1
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 Patient Name
QPD-4.1 Family Name
QPD-4.1.1 Surname McKay
QPD-4.2 Given Name Selma
QPD-4.3 Second and Further Given Names or Initials Thereof Nadia
QPD-4.7 Name Type Code L
QPD-5 Patient Mother Maiden Name
QPD-5.1 Family Name
QPD-5.1.1 Surname Schroeder
QPD-5.2 Given Name
QPD-5.7 Name Type Code M
QPD-6 Patient Date of Birth
QPD-6.1 Time 20230205
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 600 Cherry Rd.
QPD-8.2 Other Designation
QPD-8.3 City Springfield
QPD-8.4 State or Province OR
QPD-8.5 Zip or Postal Code 97477
QPD-8.6 Country USA
QPD-8.7 Address Type P
QPD-9 Patient Home Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 541
QPD-9.7 Local Number 5551236
QPD-10 Patient Multiple Birth Indicator Y
QPD-11 Patient Birth Order 1

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3 Patient Identifier List
PID-3.1 ID Number 3333
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID IIP-MPI-1
PID-3.4.2 Universal ID
PID-3.4.3 Universal ID Type
PID-3.5 Identifier Type Code MR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Selma
PID-5.2 Given Name Nadia
PID-5.3 Second and Further Given Names or Initials Thereof McKay
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 20230205
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 600 Cherry Rd.
PID-11.2 Other Designation
PID-11.3 City Springfield
PID-11.4 State or Province OR
PID-11.5 Zip or Postal Code 97477
PID-11.6 Country USA
PID-11.7 Address Type P
PID-30 Patient Death Indicator N

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 12345
ORC-3.2 Namespace ID OBH
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OBH
ORC-17.2 Text Oregon Birthing Hospital
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3086
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3087
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3095
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3096
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3097
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3083
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3084
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3085
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3089
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3090
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3091
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3092
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3093
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3094
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3098
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3088
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3099
ORC-3.2 Namespace ID WOP
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier WOP
ORC-17.2 Text Western Oregon Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID IIPIIS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname
ORC-10.3 Given Name
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text
ORC-17.3 Name of Coding System
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230205
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hep B, ped/adol
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230305
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hep B, ped/adol
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230805
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hep B, ped/adol
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230405
RXA-5 Administered Code
RXA-5.1 Identifier 116
RXA-5.2 Text Rotavirus RotaTeq)
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230605
RXA-5 Administered Code
RXA-5.1 Identifier 116
RXA-5.2 Text Rotavirus RotaTeq)
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230805
RXA-5 Administered Code
RXA-5.1 Identifier 116
RXA-5.2 Text Rotavirus RotaTeq)
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230405
RXA-5 Administered Code
RXA-5.1 Identifier 120
RXA-5.2 Text DTaP-Hib-IPV Pentac
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230605
RXA-5 Administered Code
RXA-5.1 Identifier 120
RXA-5.2 Text DTaP-Hib-IPV Pentac
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230805
RXA-5 Administered Code
RXA-5.1 Identifier 120
RXA-5.2 Text DTaP-Hib-IPV Pentac
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230805
RXA-5 Administered Code
RXA-5.1 Identifier 158
RXA-5.2 Text Influenza Quad W/Pres
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230902
RXA-5 Administered Code
RXA-5.1 Identifier 158
RXA-5.2 Text Influenza Quad W/Pres
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230405
RXA-5 Administered Code
RXA-5.1 Identifier 216
RXA-5.2 Text PCV20
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230605
RXA-5 Administered Code
RXA-5.1 Identifier 216
RXA-5.2 Text PCV20
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230805
RXA-5 Administered Code
RXA-5.1 Identifier 216
RXA-5.2 Text PCV20
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240205
RXA-5 Administered Code
RXA-5.1 Identifier 216
RXA-5.2 Text PCV20
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240205
RXA-5 Administered Code
RXA-5.1 Identifier 149
RXA-5.2 Text Hib PRP-OMP
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240205
RXA-5 Administered Code
RXA-5.1 Identifier 94
RXA-5.2 Text MMRV
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20230805
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text MMR
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Information - Source Unspecified
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID UKN
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20231107
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text No Vaccine Administered
RXA-5.3 Name of Coding System CVX
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230305

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230305

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230305

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230305

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230305

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230305

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230305

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230305

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text Rotavirus NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text Rotavirus NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text Rotavirus NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text DTaP NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier 89
OBX-5.2 Text Polio NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 10
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 11
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 12
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text DTaP NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier 89
OBX-5.2 Text Polio NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 10
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 11
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 12
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text DTaP NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier 89
OBX-5.2 Text Polio NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 10
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 11
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 12
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text Influenza NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text Influenza NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230902

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230902

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230902

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230902

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text Pneumococcal NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text Pneumococcal NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230605

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text Pneumococcal NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text Pneumococcal NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 94
OBX-5.2 Text MMRV NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240205

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose Validity
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value N
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text Dose Number in Series
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text Not Applicable
OBX-6.3 Name of Coding System HL70353
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20230805

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date dose should be given
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20240305
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date Vaccine Due
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20270205
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20300304
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59783-1
OBX-3.2 Text Series Status
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier LA13422-3
OBX-5.2 Text On Schedule
OBX-5.3 Name of Coding System LN
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date dose should be given
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 20240505
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date Vaccine Due
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 20270205
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 10
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 20300304
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 11
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59783-1
OBX-3.2 Text Series Status
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier LA13422-3
OBX-5.2 Text On Schedule
OBX-5.3 Name of Coding System LN
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 12
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 13
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value
OBX-5.1 Identifier 150
OBX-5.2 Text Influenza Quad Inj P
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 14
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date dose should be given
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 20240701
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 15
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date Vaccine Due
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 20240701
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 16
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59783-1
OBX-3.2 Text Series Status
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value
OBX-5.1 Identifier LA13422-3
OBX-5.2 Text On Schedule
OBX-5.3 Name of Coding System LN
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 17
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 18
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value
OBX-5.1 Identifier 213
OBX-5.2 Text COVID-19
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 19
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date dose should be given
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value 20230805
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 20
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date Vaccine Due
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value 20230805
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 21
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59783-1
OBX-3.2 Text Series Status
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value
OBX-5.1 Identifier LA13422-3
OBX-5.2 Text On Schedule
OBX-5.3 Name of Coding System LN
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 22
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 23
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value
OBX-5.1 Identifier 20
OBX-5.2 Text DTaP
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 24
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date dose should be given
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value 20240505
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 25
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date Vaccine Due
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value 20240505
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 26
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value 20241002
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 27
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59783-1
OBX-3.2 Text Series Status
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value
OBX-5.1 Identifier LA13422-3
OBX-5.2 Text On Schedule
OBX-5.3 Name of Coding System LN
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 28
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 29
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value
OBX-5.1 Identifier 83
OBX-5.2 Text Hep A, ped/adol, 2D
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 30
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date dose should be given
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value 20240205
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 31
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date Vaccine Due
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value 20240205
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 32
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value 20250304
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 33
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59783-1
OBX-3.2 Text Series Status
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value
OBX-5.1 Identifier LA13422-3
OBX-5.2 Text On Schedule
OBX-5.3 Name of Coding System LN
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 34
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 35
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text Polio-IPV
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 36
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date dose should be given
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value 20270205
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 37
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date Vaccine Due
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value 20270205
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 38
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value 20290901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 39
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59783-1
OBX-3.2 Text Series Status
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value
OBX-5.1 Identifier LA13422-3
OBX-5.2 Text On Schedule
OBX-5.3 Name of Coding System LN
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 40
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 41
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 14
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text Rotavirus NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 42
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59783-1
OBX-3.2 Text Series Status
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 14
OBX-5 Observation Value
OBX-5.1 Identifier LA13421-5
OBX-5.2 Text Complete
OBX-5.3 Name of Coding System LN
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 43
OBX-2 Value Type ST
OBX-3 Observation Identifier
OBX-3.1 Identifier 30982-3
OBX-3.2 Text Reason Code
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 14
OBX-5 Observation Value Patient Series is complete
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 44
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 14
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 45
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text Vaccine Type
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 15
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B NOS
OBX-5.3 Name of Coding System CVX
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 46
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59783-1
OBX-3.2 Text Series Status
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 15
OBX-5 Observation Value
OBX-5.1 Identifier LA13421-5
OBX-5.2 Text Complete
OBX-5.3 Name of Coding System LN
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 47
OBX-2 Value Type ST
OBX-3 Observation Identifier
OBX-3.1 Identifier 30982-3
OBX-3.2 Text Reason Code
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 15
OBX-5 Observation Value Patient Series is complete
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 48
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule Used
OBX-3.3 Name of Coding System LN
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 15
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID SNM 4.2.0 - Query sent to the IIS
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.


Patient Information
Patient Identifier Patient Name DOB Gender Tester Comment
3333 Nadia McKay Selma 02/05/2023 Female
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.

Evaluated Immunization History and Immunization Forecast
Immunization Schedule Used Tester Comment
ACIP

Evaluated Immunization History
Vaccine Group Vaccine Administered Date Administered Valid Dose Validity Reason Completion Status* Tester Comment
Hep B NOS Hep B, ped/adol 02/05/2023 YES Complete
Hep B NOS Hep B, ped/adol 03/05/2023 YES Complete
Hep B NOS Hep B, ped/adol 08/05/2023 YES Complete
Rotavirus NOS Rotavirus RotaTeq) 04/05/2023 YES Complete
Rotavirus NOS Rotavirus RotaTeq) 06/05/2023 YES Complete
Rotavirus NOS Rotavirus RotaTeq) 08/05/2023 YES Complete
DTaP NOS DTaP-Hib-IPV Pentac 04/05/2023 YES Complete
Hib NOS DTaP-Hib-IPV Pentac 04/05/2023 YES Complete
Polio NOS DTaP-Hib-IPV Pentac 04/05/2023 YES Complete
DTaP NOS DTaP-Hib-IPV Pentac 06/05/2023 YES Complete
Hib NOS DTaP-Hib-IPV Pentac 06/05/2023 YES Complete
Polio NOS DTaP-Hib-IPV Pentac 06/05/2023 YES Complete
DTaP NOS DTaP-Hib-IPV Pentac 08/05/2023 YES Complete
Hib NOS DTaP-Hib-IPV Pentac 08/05/2023 YES Complete
Polio NOS DTaP-Hib-IPV Pentac 08/05/2023 YES Complete
Influenza NOS Influenza Quad W/Pres 08/05/2023 YES Complete
Influenza NOS Influenza Quad W/Pres 09/02/2023 YES Complete
Pneumococcal NOS PCV20 04/05/2023 YES Complete
Pneumococcal NOS PCV20 06/05/2023 YES Complete
Pneumococcal NOS PCV20 08/05/2023 YES Complete
Pneumococcal NOS PCV20 02/05/2024 YES Complete
Hib NOS Hib PRP-OMP 02/05/2024 YES Complete
MMRV NOS MMRV 02/05/2024 YES Complete
MMR NOS MMR 08/05/2023 NO Complete
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".

Immunization Forecast
Vaccine Group Due Date Earliest Date To Give Latest Date to Give Tester Comment
MMR 02/05/2027 03/05/2024
Varicella 02/05/2027 05/05/2024
Influenza Quad Inj P 07/01/2024 07/01/2024
COVID-19 08/05/2023 08/05/2023
DTaP 05/05/2024 05/05/2024
Hep A, ped/adol, 2D 02/05/2024 02/05/2024
Polio-IPV 02/05/2027 02/05/2027
Rotavirus NOS
Hep B NOS

4.3. SNM 4.3.0 - Compare IIS-provided information

Test Story

Description

See test steps for details



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


4.3.1. 4.3.1 - Reconcile and import IIS history and forecast response

Test Step Type: SUT_MANUAL

Test Story

Description

The IIS returns an evaluated immunization history and forecast (Z42 profile message) to the SUT in response to the query for patient (Selma Nadia McKay)

The SUT shall allow user to compare IIS supplied immunization history with existing local system medical record.



Pre-condition

A query for Selma Nadia McKay's evaluated immunization history and forecast (profile Z44 message) has been sent from the SUT to the IIS.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

The patient's immunization history once only known by the IIS has been compared with the SUT's records by a practitioner.

Go to step 4.4.1


Test Objectives

To test the ability that the SUT shall allow user to compare IIS supplied immunization history with existing local system medical record.



Evaluation Criteria

The practioner reviews the immunization history from the IIS and compares to the immunization history in the SUT. The practitioner reviews the information from these sources, identifying information known only to the IIS, and identifying information that is more accurately reflected in the SUT:

Known to the SUT and IIS:

Vaccine Given (CVX)DateSource
Hep B, Adol/peds (08)02/05/2023Historical from other provider


As the SUT's data for this dose is more complete than the IIS dose data, the practitioner does not select the above dose from the IIS to be imported.

Known to the SUT but not the IIS

Vaccine Given (CVX)DateSource
Hep A, ped/adol, 2 dose (CVX 83)12/22/2023Historical from other provider


This is the same dose recorded within the SUT in step 3.12.2: Record the vaccination that is related to an adverse event. This supports test step 3.13.2 - Inform administering user of previous adverse event .
Although the SUT may be configured to trigger a report of this vaccine dose to the IIS, for the purpose of this test, assume the IIS did not successfully store this information.
Therefore, this information was not provided by the IIS as part of the patient's evaluated immunization history.

Not known to the SUT but known the IIS:


Vaccine Given (CVX)DateSourceValidity
DTaP-Hib-IPV (120)6/5/2023Historical information - from public agencyValid
DTaP-Hib-IPV (120)8/5/2023Historical information - from public agencyValid
DTaP-Hib-IPV (120)4/5/2023Historical information - from public agencyValid
Hep B, Adol/peds (08)3/5/2023Historical information - from public agencyValid
Hep B, Adol/peds (08)8/5/2023Historical information - from public agencyValid
Hib PRP-OMP (149)2/5/2024Historical information - from public agencyValid
Influenza, injectable, quadrivalent (158)8/5/2023Historical information - from public agencyValid
Influenza, injectable, quadrivalent (158)9/2/2023Historical information - from public agencyValid
MMR 8/5/2023Historical information - from public agencyInvalid
MMRV (94)2/5/2024Historical information - from public agencyValid
PCV20 (216)4/5/2023Historical information - from public agencyValid
PCV20 (216)6/5/2023Historical information - from public agencyValid
PCV20 (216)8/5/2023Historical information - from public agencyValid
PCV20 (216)2/5/2024Historical information - from public agencyValid
Rotavirus, pentavalent (116)4/5/2023Historical information - from public agencyValid
Rotavirus, pentavalent (116)6/5/2023Historical information - from public agencyValid
Rotavirus, pentavalent (116)8/5/2023Historical information - from public agencyValid


The doses listed above shall all be selected by a practitioner for reconciliation so that the SUT will have the patient's complete immunization history.


Notes

The Rotavirus vaccine should not appear in the forecast for children older than 15 weeks who have not been immunized.

RSV is not included in this test plan forecast but may be included in your results-not evaluated.



4.4. SNM 4.4.0 - Display SUT vaccination history, includes user-reconciled IIS-provided information

Test Story

Description

Display SUT vaccination history which includes user-reconciled IIS-provided information.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


4.4.1. 4.4.1 - Display SUT vaccination history, includes user-reconciled IIS-provided information

Test Step Type: SUT_MANUAL

Test Story

Description

The SUT shall display SUT vaccination history which includes user-reconciled IIS-provided information. The SUT displays all of the patient’s vaccination history including the 2 vaccines known only to the SUT and the 17 vaccines known to the IIS.



Pre-condition

The patient's immunization history once only known by the IIS has been compared with the SUT's records by a practitioner.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

The patient's immunization forecast is updated.

Go to step 4.5.1


Test Objectives

To test the ability that the SUT shall display all of the patient’s vaccination history including the 2 vaccines known only to the SUT and the 17 vaccines known to the IIS.



Evaluation Criteria

The following vaccination records of 19 historical vaccines sent to the IIS represent a complete, reconciled vaccination record for the patient. The SUT displays and identifies the source of each record.


Vaccine Given (CVX)DateSourceValidity
DTaP-Hib-IPV (120)4/5/2023Historical information - from public agencyValid
DTaP-Hib-IPV (120)6/5/2023Historical information - from public agencyValid
DTaP-Hib-IPV (120)8/5/2023Historical information - from public agencyValid
Hep A, ped/adol, 2 dose (CVX 83)12/22/2023Historical information - from other providerValid
Hep B, Adol/peds (08)02/05/2023Historical information - from other providerValid
Hep B, Adol/peds (08)3/5/2023Historical information - from public agencyValid
Hep B, Adol/peds (08)8/5/2023Historical information - from public agencyValid
Hib PRP-OMP (149)2/5/2024Historical information - from public agencyValid
Influenza, injectable, quadrivalent (158)8/5/2023Historical information - from public agencyValid
Influenza, injectable, quadrivalent (158)9/2/2023Historical information - from public agencyValid
MMR 8/5/2023Historical information - from public agencyValid
MMRV (94)2/5/2024Historical information - from public agencyInvalid
PCV20 (216)4/5/2023Historical information - from public agencyValid
PCV20 (216)6/5/2023Historical information - from public agencyValid
PCV20 (216)8/5/2023Historical information - from public agencyValid
PCV20 (216)2/5/2024Historical information - from public agencyValid
Rotavirus, pentavalent (116)4/5/2023Historical information - from public agencyValid
Rotavirus, pentavalent (116)6/5/2023Historical information - from public agencyValid
Rotavirus, pentavalent (116)8/5/2023Historical information - from public agencyValid

Notes

The Rotavirus vaccine should not appear in the forecast for children older than 15 weeks who have not been immunized.

RSV is not included in this test plan forecast but may be included in your results-not evaluated.



4.5. SNM 4.5.0 - Re-evaluate patient's immunization forecast

Test Story

Description

After reconciling IIS provided vaccine records with those in the SUT, the forecast provided by the SUT is updated.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Evaluation Criteria

See test step for details



4.5.1. 4.5.1 - Re-evaluate patient's immunization forecast after reconciling IIS-provided vaccine history

Test Step Type: SUT_MANUAL

Test Story

Description

Practitioner shall Re-evaluate patient's immunization forecast after 1) IIS-provided information is reconciled by a user, or 2) patient-provided information is reconciled by a user. After reconciling IIS provided vaccine records with those in the SUT, the forecast provided by the SUT is updated.



Pre-condition

The patient's immunization history once only known by the IIS has been compared with the SUT's records by a practitioner.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

The patient's recently updated vaccine forecast from the SUT is available to a practitioner.

Go to step 4.6.1


Test Objectives

The SUT displays the immunization forecast performed on the reconciled immunization history containing all vaccine data from the SUT and from the IIS in response to the Step 4.2.1 query. The proctor compares this new forecast to the pre-query forecast shown in step 4.1.1 and confirms the changes for each vaccine listed; two of the vaccines (Hep B and Pneumococcal) are no longer listed in the new forecast as the series for each is now complete.



Evaluation Criteria

The list of vaccines is being evaluated not the dates listed.

The new SUT forecast displays updated recommended vaccines post-reconciliation: 

Pre-forecast vaccines
DTaP, Tdap or Td     
COVID
HepA                 
Hep B
Influenza            
MMR                  
Polio                
Pneumococcal
Varicella            
Post-forecast vaccines
DTaP, Tdap or Td     
COVID
HepA                 

Influenza            
MMR                  
Polio                

Varicella            

Notes

The Rotavirus vaccine should not appear in the forecast for children older than 15 weeks who have not been immunized.

RSV is not included in this test plan forecast but may be included in your results-not evaluated.


4.6. 4.6.0 - Non Match RSP

Test Story

Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Evaluation Criteria

See test steps for details.


4.6.1. JJS 4.6.1 Not Evaluated-Select Patient: Receive and process outcomes from IIS noting too many matches

Test Step Type: SUT_MANUAL

Test Story

Description

Nurse Daniela Wyatt uses SUT to access the medical records of James John Smith, specifically the area of the record that permits a query to the IIS for evaluated history and forecast.



Pre-condition

James John Smith has a medical record within the SUT containing demographic data.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

James John Smith's record is selected.

Go to step 4.6.2


Test Objectives

The SUT is able to select patients for the purpose of performing subsequent actions.



Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.



Notes
ID Number6666
FirstJames
MiddleJohn
LastSmith
Suffix
Date of Birth04/05/1974
SexMale
Race¹Black or African American
Ethnicity¹Not Hispanic or Latino
Permanent Address¹
Address Line 1¹600 Locust Ln
Address Line 2
City¹Springfield
State¹OR
Zip Code¹97477
Country¹USA
Phone Number¹(541) 555-0006
Use¹Primary Residence Number
Type¹Telephone
Part of a multiple birth?¹No
Birth order¹1
Reminder Recall¹Reminder/recall - any method
Protected?¹No
IIS Status¹Active
Deceased?¹No
Vaccine Program Eligibility¹Not VFC eligible
0
¹ - If required by the SUT

4.6.2. JJS 4.6.2 Not evaluated: Requests (query) a patient's evaluated immunization history and vaccine forecast from an IIS

Test Step Type: SUT_INITIATOR

Test Story

Description

Nurse, Daniela Wyatt, uses SUT to query James John Smith DOB 4/05/1974, for an evaluated immunization history and forecast.



Pre-condition

James John Smith's demographic data are stored within the SUT.


The IIS has multiple people named, "James John Smith" with a date of birth of 04/05/1974 in its database.

Daniela Jennifer Wyatt is the practitioner.



Post-Condition

A query for James John Smith's evaluated immunization history and forecast (profile Z44 message) has been sent from the SUT to the IIS.

Go to step 4.6.3 to receive and process RSP from this step.


Test Objectives

The SUT is able to query the IIS for patient's of interest.



Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.

It is anticipated that the message's Query by Parameter (QDP) segment contains the following patient information:

Patient Information
ElementData
Patient NameJames John Smith
Mother's Maiden Name
ID Number6666
Date/Time of Birth04/05/1974
Administrative SexMale
Patient Address600 Locust Ln Springfield, OR 97477 USA
Phone Number(541) 555-0006 (Telephone=PH)
Multiple Birth IndicatorN
Birth Order1


- Limits the query response to one response (RCP-2.1 = 1)

Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405093021-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code QBP Value-Profile Fixed
MSH-9.2 Trigger Event Q11 Value-Profile Fixed
MSH-9.3 Message Structure QBP_Q11 Value-Profile Fixed
MSH-10 Message Control ID IIP4102 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID OFM Presence-Configuration
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code XX Value-Test Case Fixed
MSH-22.10 Organization Identifier 197028 Presence-Configuration
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID IIP Presence-Configuration
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code XX Value-Test Case Fixed
MSH-23.10 Organization Identifier 197027 Presence-Configuration

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44 Value-Test Case Fixed
QPD-1.2 Text Request Evaluated History and Forecast Value-Test Case Fixed
QPD-1.3 Name of Coding System CDCPHINVS Value-Profile Fixed
QPD-1.4 Alternate Identifier
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IIPQUERY3 Presence-System Generated
QPD-3 Patient List
QPD-3.1 ID Number 6666 Value-Test Case Fixed
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID IIP-MPI-1 Value-Test Case Fixed
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR Value-Test Case Fixed
QPD-4 Patient Name
QPD-4.1 Family Name
QPD-4.1.1 Surname Smith Value-Test Case Fixed
QPD-4.2 Given Name James Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof John Presence-Content Indifferent
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 Patient Mother Maiden Name
QPD-5.1 Family Name
QPD-5.1.1 Surname
QPD-5.2 Given Name
QPD-5.7 Name Type Code
QPD-6 Patient Date of Birth
QPD-6.1 Time 19740405 Presence-System Generated
QPD-7 Patient Sex M Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 600 Locust Ln Value-Test Case Fixed
QPD-8.2 Other Designation
QPD-8.3 City Springfield Value-Test Case Fixed
QPD-8.4 State or Province OR Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 97477 Value-Test Case Fixed
QPD-8.6 Country USA Value-Test Case Fixed
QPD-8.7 Address Type P Value-Test Case Fixed
QPD-9 Patient Home Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 541 Value-Test Case Fixed
QPD-9.7 Local Number 5550006 Value-Test Case Fixed
QPD-10 Patient Multiple Birth Indicator N Value-Test Case Fixed
QPD-11 Patient Birth Order 1 Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I Value-Test Case Fixed
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1 Value-Test Case Fixed
RCP-2.2 Units
RCP-2.2.1 Identifier RD Value-Profile Fixed
RCP-2.2.2 Text Records Presence-Test Case Proper
RCP-2.2.3 Name of Coding System HL70126 Value-Profile Fixed
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name James John Smith
Mother's Maiden Name
ID Number 6666
Date/Time of Birth 04/05/1974
Sex Male
Patient Address 600 Locust Ln Springfield OR 97477 USA
Patient Phone (541)555-0006
Birth Indicator No
Birth Order 1

4.6.3. JJS 4.6.3 - Receive and process outcomes from IIS noting too many clients match the criteria sent query-response

Test Step Type: TA_RESPONDER

Test Story

Description

After receiving a query for the patient's evaluated history and forecast, the IIS generates and sends an acknowledgment (ACK -- Z33 Profile) message from an IIS that indicates too many matches.



Pre-condition

A query for James John Smith's evaluated immunization history and forecast (profile Z44 message) has been sent from the SUT to the IIS.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

SUT's receives an acknowledgment (ACK -- Z33 Profile) message from an IIS that indicates too many matches.

A SUT user is provided some indication that too many matches were found.

Go to step 4.6.4


Test Objectives

Tests the ability of the SUT to process a response message that returns too many matches (i.e., no patients are returned for that reason) and to provide an indication to the end user.


Evaluation Criteria

The SUT shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but too many matching records were found for the person in the query.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405093021-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID IIP-RSP-3
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z33
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID IIP4102

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IIPQUERY3
QAK-2 Query Response Status TM
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.4 Alternate Identifier
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.4 Alternate Identifier
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IIPQUERY3
QPD-3 Patient List
QPD-3.1 ID Number 6666
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID IIP-MPI-1
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 Patient Name
QPD-4.1 Family Name
QPD-4.1.1 Surname Smith
QPD-4.2 Given Name James
QPD-4.3 Second and Further Given Names or Initials Thereof John
QPD-4.7 Name Type Code L
QPD-5 Patient Mother Maiden Name
QPD-5.1 Family Name
QPD-5.1.1 Surname
QPD-5.2 Given Name
QPD-5.7 Name Type Code
QPD-6 Patient Date of Birth
QPD-6.1 Time 19740405
QPD-7 Patient Sex M
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 600 Locust Ln
QPD-8.2 Other Designation
QPD-8.3 City Springfield
QPD-8.4 State or Province OR
QPD-8.5 Zip or Postal Code 97477
QPD-8.6 Country USA
QPD-8.7 Address Type P
QPD-9 Patient Home Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 541
QPD-9.7 Local Number 5550006
QPD-10 Patient Multiple Birth Indicator N
QPD-11 Patient Birth Order 1

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID 4.6.0 - Non Match RSP
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display information notifying the HIT user that a Return Acknowledgement with No Person Records Z33 message was received (in response to an Evaluated Immunization History and Immunization Forecast Z44 query message). Additional data from the message or from the EHR are permitted to be displayed by the EHR.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The data shown in this Juror Document are derived from the test data provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.


Patient Information
Patient Identifier Patient Name DOB Gender Tester Comment
6666 James John Smith 04/05/1974 Male
When displayed in the EHR with the notification indicating that a Return Acknowledgement with No Person Records Z33 message was received, these patient demographics data are derived from the EHR patient record.

Evaluated Immunization History and Immunization Forecast
The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but too many matching records were found for the person in the query.

4.6.4. FMN 4.6.4 Not Evaluated-Select Patient: Receive and process outcomes from IIS noting non match outcomes

Test Step Type: SUT_MANUAL

Test Story

Description

Nurse Daniela Wyatt uses SUT to access the medical records of Franklin Mayhew Nesbitt, DOB 04/05/1984, specifically the area of the record that permits a query to the IIS for evaluated history and forecast.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.

Franklin Mayhew Nesbitt's exists in the SUT.


Post-Condition

Franklin Mayhew Nesbitt's record is selected.

Go to step 4.6.5


Test Objectives

The SUT is able to select a patient for the purpose of performing subsequent actions.



Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.



Notes
ID Number5555
ID TypeMedical record number
FirstFranklin
MiddleMayhew
LastNesbitt
Suffix
Date of Birth04/05/1984
SexMale
Race¹Asian
Ethnicity¹Not Hispanic or Latino
Permanent Address¹
Address Line 1¹400 Fir Rd.
Address Line 2
City¹Springfield
State¹OR
Zip Code¹97477
Country¹USA
Phone Number¹(541) 555-1209
Use¹Primary Residence Number
Type¹Telephone
Part of a multiple birth?¹No
Birth order¹1
Reminder Recall¹Reminder/recall - any method
Protected?¹No
IIS Status¹Active
Deceased?¹No
Vaccine Program Eligibility¹Not VFC eligible


¹ - If required by the SUT

4.6.5. FMN 4.6.5 Not evaluated: Requests (query) a patient's evaluated immunization history and vaccine forecast from an IIS

Test Step Type: SUT_INITIATOR

Test Story

Description

Nurse, Daniela Wyatt, uses SUT to query Franklin Mayhew Nesbitt evaluated immunization history and forecast.



Pre-condition

Franklin Mayhew Nesbitt's demographic data are stored within the SUT.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

A query for Franklin Mayhew Nesbitt's evaluated immunization history and forecast (profile Z44 message) has been sent from the SUT to the IIS.

Go to step 4.6.6 to receive and process RSP from this step.


Test Objectives

The SUT is able to query the IIS for a patient's immunization and forecast.



Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.

It is anticipated that the the message's Query by Parameter (QDP) segment contains the following patient information:

Patient Information
ElementData
Patient NameFranklin Mayhew Nesbitt
Mother's Maiden Name
ID Number5555
Date/Time of Birth04/05/1974
Administrative SexMale
Patient Address400 Fir Rd. Springfield, OR 97477 USA
Phone Number(541) 000-1209 (Telephone=PH)
Multiple Birth IndicatorN
Birth Order1


- Limits the query response to one response (RCP-2.1 = 1)

Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405093021-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code QBP Value-Profile Fixed
MSH-9.2 Trigger Event Q11 Value-Profile Fixed
MSH-9.3 Message Structure QBP_Q11 Value-Profile Fixed
MSH-10 Message Control ID IIP4102 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID OFM Presence-Configuration
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code XX Value-Test Case Fixed
MSH-22.10 Organization Identifier 197028 Presence-Configuration
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID IIP Presence-Configuration
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code XX Value-Test Case Fixed
MSH-23.10 Organization Identifier 197027 Presence-Configuration

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44 Value-Test Case Fixed
QPD-1.2 Text Request Evaluated History and Forecast Value-Test Case Fixed
QPD-1.3 Name of Coding System CDCPHINVS Value-Profile Fixed
QPD-1.4 Alternate Identifier
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IIPQUERY4 Presence-System Generated
QPD-3 Patient List
QPD-3.1 ID Number 5555 Value-Test Case Fixed
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID IIP-MPI-1 Value-Test Case Fixed
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR Value-Test Case Fixed
QPD-4 Patient Name
QPD-4.1 Family Name
QPD-4.1.1 Surname Nesbitt Value-Test Case Fixed
QPD-4.2 Given Name Franklin Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Mayhew Presence-Content Indifferent
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 Patient Mother Maiden Name
QPD-5.1 Family Name
QPD-5.1.1 Surname
QPD-5.2 Given Name
QPD-5.7 Name Type Code
QPD-6 Patient Date of Birth
QPD-6.1 Time 19840405 Presence-System Generated
QPD-7 Patient Sex M Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 400 Fir Rd. Value-Test Case Fixed
QPD-8.2 Other Designation
QPD-8.3 City Springfield Value-Test Case Fixed
QPD-8.4 State or Province OR Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 97477 Value-Test Case Fixed
QPD-8.6 Country USA Value-Test Case Fixed
QPD-8.7 Address Type P Value-Test Case Fixed
QPD-9 Patient Home Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 541 Value-Test Case Fixed
QPD-9.7 Local Number 5551209 Value-Test Case Fixed
QPD-10 Patient Multiple Birth Indicator N Value-Test Case Fixed
QPD-11 Patient Birth Order 1 Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I Value-Test Case Fixed
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1 Value-Test Case Fixed
RCP-2.2 Units
RCP-2.2.1 Identifier RD Value-Profile Fixed
RCP-2.2.2 Text Records Presence-Test Case Proper
RCP-2.2.3 Name of Coding System HL70126 Value-Profile Fixed
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Franklin Mayhew Nesbitt
Mother's Maiden Name
ID Number 5555
Date/Time of Birth 04/05/1984
Sex Male
Patient Address 400 Fir Rd. Springfield OR 97477 USA
Patient Phone (541)555-1209
Birth Indicator No
Birth Order 1

4.6.6. FMN 4.6.6 - Receive and process outcomes from IIS noting no clients match the criteria sent within the query from the SUT

Test Step Type: TA_RESPONDER

Test Story

Description

The IIS performs a search for Franklin Mayhew Nesbitt and does not find a high-confidence match. The IIS returns a response message indicating no person found in the querying system.



Pre-condition

No data exists in the IIS database for Franklin Mayhew Nesbitt

A query for Franklin Mayhew Nesbitt's evaluated immunization history and forecast (profile Z44 message) has been sent from the SUT to the IIS.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

The response message is processed and an SUT user is alerted to fact of no matches.

Go to step 3.14.1


Test Objectives

Test the ability of the SUT to process a response message that returns no persons found and to provide an indication to the end user.



Evaluation Criteria

The SUT shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but no matching records were found for the person in the query.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405093021-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID IIP-RSP-3
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z33
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID IIP4102

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IIPQUERY4
QAK-2 Query Response Status NF
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.4 Alternate Identifier
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.4 Alternate Identifier
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IIPQUERY4
QPD-3 Patient List
QPD-3.1 ID Number 5555
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID IIP-MPI-1
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 Patient Name
QPD-4.1 Family Name
QPD-4.1.1 Surname Nesbitt
QPD-4.2 Given Name Franklin
QPD-4.3 Second and Further Given Names or Initials Thereof Mayhew
QPD-4.7 Name Type Code L
QPD-5 Patient Mother Maiden Name
QPD-5.1 Family Name
QPD-5.1.1 Surname
QPD-5.2 Given Name
QPD-5.7 Name Type Code
QPD-6 Patient Date of Birth
QPD-6.1 Time 19840405
QPD-7 Patient Sex M
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 400 Fir Rd.
QPD-8.2 Other Designation
QPD-8.3 City Springfield
QPD-8.4 State or Province OR
QPD-8.5 Zip or Postal Code 97477
QPD-8.6 Country USA
QPD-8.7 Address Type P
QPD-9 Patient Home Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 541
QPD-9.7 Local Number 5551209
QPD-10 Patient Multiple Birth Indicator N
QPD-11 Patient Birth Order 1

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID 4.6.0 - Non Match RSP
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display information notifying the HIT user that a Return Acknowledgement with No Person Records Z33 message was received (in response to an Evaluated Immunization History and Immunization Forecast Z44 query message). Additional data from the message or from the EHR are petermitted to be displayed by the EHR.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The data shown in this Juror Document are derived from the test data provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.


Patient Information
Patient Identifier Patient Name DOB Gender Tester Comment
5555 Franklin Mayhew Nesbitt 04/05/1984 Male
When displayed in the EHR with the notification indicating that a Return Acknowledgement with No Person Records Z33 message was received, these patient demographics data are derived from the EHR patient record.

Evaluated Immunization History and Immunization Forecast
The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but no matching records were found for the person in the query.

5. 5.0.0 - Capability: Transmission & Acknowledgment

Test Story

Description

The SUT supports the ability to send newly documented patient immunization records to the IIS.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Evaluation Criteria

See test step for details.



5.1. LGD 5.1.0 - Transmit newly recorded immunization records to IIS

Test Story

Description

The SUT supports the ability to send newly documented patient immunization records to the IIS.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Evaluation Criteria

See test step for details. Use HIMSS IIP Test Plan v11.0 Job Aid for DOB, vaccination dates, effective dates, VIS presentation dates, forecast dates.

Located in NIST under User Documentation



5.1.1. 5.1.1 - Transmit newly recorded administered vaccine documented within the SUT to the IIS

Test Step Type: SUT_INITIATOR

Test Story

Description

The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step.

This includes four doses of newly administered vaccines.



Pre-condition

Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0.

Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users. This was performed in Test Step 3.6.1.

Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1.

Daniela Jennifer Wyatt is the practitioner.



Post-Condition

The newly administered vaccine doses are visible in the SUT and the IIS.

Go to the Step 5.2.1 and then repeat the transmit 5.1.1 to receive and process the additional ACKs with issues to be processed by the SUT.


Test Objectives

To test the ability that the SUT is able to send newly administration vaccine doses to the IIS.


The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Both NDC and CVX are required for new immunizations and CVX is required for historical.


Support for mother's maiden name, patient full middle name, next of kin, next of kin full middle name.


Support for both phone number and email of patient and first next of kin.


Support for patient consent


Support for VIS, funding source and VFC data

Support for Telecommunication Equipment Type


Evaluation Criteria

The IIS received a single VXU message with multiple RXA segments from the SUT containing newly administered vaccine doses recorded in the SUT.

The IIS received a single VXU message with multiple OBX segments from the SUT containing VFC eligibility for the newly administered vaccine doses recorded in the SUT.

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22).  The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

The VXU content should match the information displayed below: (DOB and actual dates of administration must be present but are not evaluated)

This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.

Patient Information
ElementData
Patient NameLance Gaige Duncan, Jr.
Mother s Maiden NameKing
ID Number1111
Date/Time of BirthUse the HIMSS IIP Test Plan v11.0 Job Aid
Today (day of test) the patient is 0 years, 1 months, and 17 days old
Administrative SexMale
Patient Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone = CP)
E-mail AddressIIPMP@gmail.com
RaceAmerican Indian or Alaska Native
Ethnic GroupNot Hispanic or Latino
Multiple Birth IndicatorNo
Birth Order1


Immunization Registry Information
ElementData
Immunization Registry StatusActive
Immunization Registry Status Effective DatePatient DOB from Job Aid
Publicity CodeReminder/recall - any method
Publicity Code Effective DateToday's date
Protection IndicatorNo
Protection Indicator Effective DateToday's date


Guardian or Responsible Party - 1
ElementData
NameIngrid Stacy Duncan
RelationshipMother
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone = CP)
E-mail AddressIIPMP@gmail.com


Guardian or Responsible Party - 2
ElementData
NameSimon Isaiah Duncan, Sr
RelationshipFather
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1233 (Cellular Phone = CP)




Vaccine Administration Information -1
ElementData
Administered VaccinePEDIARIX
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN01
Substance Expiration Date9/27/2029
Substance Manufacturer NameGlaxoSmithKline
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeMulti Pediatric Vaccines VIS - 7/24/2023
Date VIS PresentedToday's date


Vaccine Administration Information - 2
ElementData
Administered VaccineActHIB
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN05
Substance Expiration Date09/27/2029
Substance Manufacturer Namesanofi pasteur
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteRight Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeHaemophilus Influenzae type b (Hib) Vaccine VIS
Date VIS PresentedToday's date


Vaccine Administration Information - 3
ElementData
Administered VaccineRotarix
Date/Time Start of AdministrationToday's date
Administered Amount1
Administered UnitsmL
Administration NotesNew immunization record
Administering Provider
Substance Lot NumberIIPVAXN07
Substance Expiration Date09/27/2029
Substance Manufacturer NameGlaxoSmithKline
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteORAL
Administration SiteN/A
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeHaemophilus Influenzae type b (Hib) Vaccine VIS
Date VIS PresentedToday's date


Vaccine Administration Information - 4
ElementData
Administered VaccinePrevnar 20
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberLLBUAYMO68
Substance Expiration Date09/27/2029
Substance Manufacturer NamePfizer, Inc
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Deltoid
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypePneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS
Date VIS PresentedToday's date



Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html


Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405131011-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID IIP-Transmit-1 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Profile Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 1111 Presence-Content Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID IIP-MPI-1 Presence-Content Indifferent
PID-3.4.2 Universal ID
PID-3.4.3 Universal ID Type
PID-3.5 Identifier Type Code MR Value-Test Case Fixed
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Duncan Value-Test Case Fixed
PID-5.2 Given Name Lance Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Gaige Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname King Value-Test Case Fixed
PID-6.2 Given Name
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20240215 Presence-Content Indifferent
PID-8 Administrative Sex M Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 1002-5 Value-Test Case Fixed
PID-10.2 Text American Indian or Alaska Native Presence-Test Case Proper
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.4 Alternate Identifier
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
PID-11.2 Other Designation Unit A Value-Test Case Fixed
PID-11.3 City Springfield Value-Test Case Fixed
PID-11.4 State or Province OR Value-Test Case Fixed
PID-11.5 Zip or Postal Code 97477 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type P Value-Test Case Fixed
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13[1].4 Email Address
PID-13[1].6 Area/City Code 541 Value-Test Case Fixed
PID-13[1].7 Local Number 5551111 Value-Test Case Fixed
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
PID-13[2].4 Email Address IIPMP@gmail.com Value-Test Case Fixed
PID-13[2].6 Area/City Code
PID-13[2].7 Local Number
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Value-Test Case Fixed
PID-22.2 Text Not Hispanic or Latino Presence-Test Case Proper
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.4 Alternate Identifier
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator N Value-Test Case Fixed

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - any method Presence-Test Case Proper
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-11.4 Alternate Identifier
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20240405 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20240126 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20240405 Presence-Content Indifferent

NK1[*]
NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Ingrid Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Stacy Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Value-Test Case Fixed
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5[1] Phone Number
NK1-5[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5[1].4 Email Address
NK1-5[1].6 Area/City Code 541 Value-Test Case Fixed
NK1-5[1].7 Local Number 5551111 Value-Test Case Fixed
NK1-5[2] Phone Number
NK1-5[2].2 Telecommunication Use Code NET Value-Test Case Fixed
NK1-5[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
NK1-5[2].4 Email Address IIPMP@gmail.com Value-Test Case Fixed
NK1-5[2].6 Area/City Code
NK1-5[2].7 Local Number

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 2 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Simon Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Isaiah Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier FTH Value-Test Case Fixed
NK1-3.2 Text Father Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Value-Test Case Fixed
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 541 Value-Test Case Fixed
NK1-5.7 Local Number 5551233 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1111 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2222 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1112 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2223 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1113 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2224 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1114 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2225 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0811-43 Value-Test Case Fixed
RXA-5.2 Text PEDIARIX Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 110 Value-Test Case Fixed
RXA-5.5 Alternate Text DTaP-Hep B-IPV Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN01 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 49281-0547-58 Value-Test Case Fixed
RXA-5.2 Text ActHIB Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 48 Value-Test Case Fixed
RXA-5.5 Alternate Text ActHIB Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN05 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text sanofi pasteur Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0740-02 Value-Test Case Fixed
RXA-5.2 Text Rotarix Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 119 Value-Test Case Fixed
RXA-5.5 Alternate Text rotavirus, monovalent Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 1 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN07 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00005-2000-01 Value-Test Case Fixed
RXA-5.2 Text Prevnar 20 Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 216 Value-Test Case Fixed
RXA-5.5 Alternate Text Pneumococcal conjugate PCV20, polysaccharide CRM197 conjugate, adjuvant, PF Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number LLBUAYMO68 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text sanofi pasteur Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LVL Value-Test Case Fixed
RXR-2.2 Text Left Vastus Lateralis Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier RVL Value-Test Case Fixed
RXR-2.2 Text Right Vastus Lateralis Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288 Value-Test Case Fixed
RXR-1.2 Text ORAL Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300026411230724 Value-Test Case Fixed
OBX-5.2 Text Multi Pediatric Vaccines VIS - 07/24/2023 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300006611210806 Value-Test Case Fixed
OBX-5.2 Text Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300019611211015 Value-Test Case Fixed
OBX-5.2 Text Rotavirus Vaccine VIS - 10/15/2021 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300049311230512 Value-Test Case Fixed
OBX-5.2 Text Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Lance Gaige Duncan
Mother's Maiden Name King
ID Number 1111
Date/Time of Birth 02/15/2024
Administrative Sex Male
Patient Address 749 Evergreen Ter. Springfield OR 97477 USA
Local Number (541)555-1111
Email IIPMP@gmail.com
Race American Indian or Alaska Native
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator No
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 01/26/2024
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 04/05/2024
Protection Indicator No
Protection Indicator Effective Date 04/05/2024
Guardian or Responsible Party[*]
Guardian or Responsible Party
Element Data
Name Ingrid Stacy Duncan
Relationship Mother
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1111
Phone Number

Guardian or Responsible Party
Element Data
Name Simon Isaiah Duncan
Relationship Father
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1233

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine PEDIARIX
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN01
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Multi Pediatric Vaccines VIS - 07/24/2023
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine ActHIB
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN05
Substance Expiration Date 09/27/2029
Substance Manufacturer Name sanofi pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Right Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine Rotarix
Date/Time Start of Administration 04/05/2024
Administered Amount 1
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN07
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route ORAL
Administration Site
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Rotavirus Vaccine VIS - 10/15/2021
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine Prevnar 20
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number LLBUAYMO68
Substance Expiration Date 09/27/2029
Substance Manufacturer Name sanofi pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Deltoid
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023
Date Vaccine Information Statement Presented 04/05/2024

5.1.2. 5.2.1 - Receive and process acknowledgment messages from IIS

Test Step Type: TA_RESPONDER

Test Story

Description

SUT is able to Receive and process acknowledgment messages from an IIS that indicate there were no errors found during the course of processing the patient immunization record.



Pre-condition

The SUT has transmitted administered vaccine.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

An acknowledgement (ACK Z23) is received and processed by the SUT.

Go to the Step 5.1.1


Test Objectives

To test the ability that the SUT is able to Receive and process acknowledgment messages from an IIS that indicate there were no errors found during the course of processing the patient immunization record.



Evaluation Criteria

The acknowledgement message AA is visible in the SUT, the system responsible for the content of the transmission message.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240115083738-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID IIP-ACK-1
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID IIP-Transmit-1

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.1.3. 5.1.1 - Transmit newly recorded administered vaccine documented within the SUT to the IIS

Test Step Type: SUT_INITIATOR

Test Story

Description

The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step.

This includes four doses of newly administered vaccines.



Pre-condition

Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0.

Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users. This was performed in Test Step 3.6.1.

Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1.

Daniela Jennifer Wyatt is the practitioner.



Post-Condition

The newly administered vaccine doses are visible in the SUT and the IIS.

Go to the Step 5.2.1 and then repeat the transmit 5.1.1 to receive and process the additional ACKs with issues to be processed by the SUT.


Test Objectives

To test the ability that the SUT is able to send newly administration vaccine doses to the IIS.


The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Both NDC and CVX are required for new immunizations and CVX is required for historical.


Support for mother's maiden name, patient full middle name, next of kin, next of kin full middle name.


Support for both phone number and email of patient and first next of kin.


Support for patient consent


Support for VIS, funding source and VFC data

Support for Telecommunication Equipment Type


Evaluation Criteria

The IIS received a single VXU message with multiple RXA segments from the SUT containing newly administered vaccine doses recorded in the SUT.

The IIS received a single VXU message with multiple OBX segments from the SUT containing VFC eligibility for the newly administered vaccine doses recorded in the SUT.

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22).  The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

The VXU content should match the information displayed below: (DOB and actual dates of administration must be present but are not evaluated)

This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.

Patient Information
ElementData
Patient NameLance Gaige Duncan, Jr.
Mother s Maiden NameKing
ID Number1111
Date/Time of BirthUse the HIMSS IIP Test Plan v11.0 Job Aid
Today (day of test) the patient is 0 years, 1 months, and 17 days old
Administrative SexMale
Patient Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone = CP)
E-mail AddressIIPMP@gmail.com
RaceAmerican Indian or Alaska Native
Ethnic GroupNot Hispanic or Latino
Multiple Birth IndicatorNo
Birth Order1


Immunization Registry Information
ElementData
Immunization Registry StatusActive
Immunization Registry Status Effective DatePatient DOB from Job Aid
Publicity CodeReminder/recall - any method
Publicity Code Effective DateToday's date
Protection IndicatorNo
Protection Indicator Effective DateToday's date


Guardian or Responsible Party - 1
ElementData
NameIngrid Stacy Duncan
RelationshipMother
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone = CP)
E-mail AddressIIPMP@gmail.com


Guardian or Responsible Party - 2
ElementData
NameSimon Isaiah Duncan, Sr
RelationshipFather
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1233 (Cellular Phone = CP)




Vaccine Administration Information -1
ElementData
Administered VaccinePEDIARIX
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN01
Substance Expiration Date9/27/2029
Substance Manufacturer NameGlaxoSmithKline
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeMulti Pediatric Vaccines VIS - 7/24/2023
Date VIS PresentedToday's date


Vaccine Administration Information - 2
ElementData
Administered VaccineActHIB
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN05
Substance Expiration Date09/27/2029
Substance Manufacturer Namesanofi pasteur
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteRight Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeHaemophilus Influenzae type b (Hib) Vaccine VIS
Date VIS PresentedToday's date


Vaccine Administration Information - 3
ElementData
Administered VaccineRotarix
Date/Time Start of AdministrationToday's date
Administered Amount1
Administered UnitsmL
Administration NotesNew immunization record
Administering Provider
Substance Lot NumberIIPVAXN07
Substance Expiration Date09/27/2029
Substance Manufacturer NameGlaxoSmithKline
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteORAL
Administration SiteN/A
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeHaemophilus Influenzae type b (Hib) Vaccine VIS
Date VIS PresentedToday's date


Vaccine Administration Information - 4
ElementData
Administered VaccinePrevnar 20
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberLLBUAYMO68
Substance Expiration Date09/27/2029
Substance Manufacturer NamePfizer, Inc
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Deltoid
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypePneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS
Date VIS PresentedToday's date



Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html


Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405131011-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID IIP-Transmit-1 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Profile Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 1111 Presence-Content Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID IIP-MPI-1 Presence-Content Indifferent
PID-3.4.2 Universal ID
PID-3.4.3 Universal ID Type
PID-3.5 Identifier Type Code MR Value-Test Case Fixed
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Duncan Value-Test Case Fixed
PID-5.2 Given Name Lance Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Gaige Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname King Value-Test Case Fixed
PID-6.2 Given Name
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20240215 Presence-Content Indifferent
PID-8 Administrative Sex M Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 1002-5 Value-Test Case Fixed
PID-10.2 Text American Indian or Alaska Native Presence-Test Case Proper
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.4 Alternate Identifier
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
PID-11.2 Other Designation Unit A Value-Test Case Fixed
PID-11.3 City Springfield Value-Test Case Fixed
PID-11.4 State or Province OR Value-Test Case Fixed
PID-11.5 Zip or Postal Code 97477 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type P Value-Test Case Fixed
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13[1].4 Email Address
PID-13[1].6 Area/City Code 541 Value-Test Case Fixed
PID-13[1].7 Local Number 5551111 Value-Test Case Fixed
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
PID-13[2].4 Email Address IIPMP@gmail.com Value-Test Case Fixed
PID-13[2].6 Area/City Code
PID-13[2].7 Local Number
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Value-Test Case Fixed
PID-22.2 Text Not Hispanic or Latino Presence-Test Case Proper
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.4 Alternate Identifier
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator N Value-Test Case Fixed

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - any method Presence-Test Case Proper
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-11.4 Alternate Identifier
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20240405 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20240126 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20240405 Presence-Content Indifferent

NK1[*]
NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Ingrid Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Stacy Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Value-Test Case Fixed
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5[1] Phone Number
NK1-5[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5[1].4 Email Address
NK1-5[1].6 Area/City Code 541 Value-Test Case Fixed
NK1-5[1].7 Local Number 5551111 Value-Test Case Fixed
NK1-5[2] Phone Number
NK1-5[2].2 Telecommunication Use Code NET Value-Test Case Fixed
NK1-5[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
NK1-5[2].4 Email Address IIPMP@gmail.com Value-Test Case Fixed
NK1-5[2].6 Area/City Code
NK1-5[2].7 Local Number

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 2 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Simon Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Isaiah Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier FTH Value-Test Case Fixed
NK1-3.2 Text Father Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Value-Test Case Fixed
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 541 Value-Test Case Fixed
NK1-5.7 Local Number 5551233 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1111 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2222 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1112 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2223 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1113 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2224 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1114 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2225 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0811-43 Value-Test Case Fixed
RXA-5.2 Text PEDIARIX Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 110 Value-Test Case Fixed
RXA-5.5 Alternate Text DTaP-Hep B-IPV Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN01 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 49281-0547-58 Value-Test Case Fixed
RXA-5.2 Text ActHIB Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 48 Value-Test Case Fixed
RXA-5.5 Alternate Text ActHIB Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN05 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text sanofi pasteur Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0740-02 Value-Test Case Fixed
RXA-5.2 Text Rotarix Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 119 Value-Test Case Fixed
RXA-5.5 Alternate Text rotavirus, monovalent Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 1 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN07 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00005-2000-01 Value-Test Case Fixed
RXA-5.2 Text Prevnar 20 Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 216 Value-Test Case Fixed
RXA-5.5 Alternate Text Pneumococcal conjugate PCV20, polysaccharide CRM197 conjugate, adjuvant, PF Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number LLBUAYMO68 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text sanofi pasteur Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LVL Value-Test Case Fixed
RXR-2.2 Text Left Vastus Lateralis Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier RVL Value-Test Case Fixed
RXR-2.2 Text Right Vastus Lateralis Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288 Value-Test Case Fixed
RXR-1.2 Text ORAL Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300026411230724 Value-Test Case Fixed
OBX-5.2 Text Multi Pediatric Vaccines VIS - 07/24/2023 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300006611210806 Value-Test Case Fixed
OBX-5.2 Text Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300019611211015 Value-Test Case Fixed
OBX-5.2 Text Rotavirus Vaccine VIS - 10/15/2021 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300049311230512 Value-Test Case Fixed
OBX-5.2 Text Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Lance Gaige Duncan
Mother's Maiden Name King
ID Number 1111
Date/Time of Birth 02/15/2024
Administrative Sex Male
Patient Address 749 Evergreen Ter. Springfield OR 97477 USA
Local Number (541)555-1111
Email IIPMP@gmail.com
Race American Indian or Alaska Native
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator No
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 01/26/2024
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 04/05/2024
Protection Indicator No
Protection Indicator Effective Date 04/05/2024
Guardian or Responsible Party[*]
Guardian or Responsible Party
Element Data
Name Ingrid Stacy Duncan
Relationship Mother
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1111
Phone Number

Guardian or Responsible Party
Element Data
Name Simon Isaiah Duncan
Relationship Father
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1233

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine PEDIARIX
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN01
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Multi Pediatric Vaccines VIS - 07/24/2023
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine ActHIB
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN05
Substance Expiration Date 09/27/2029
Substance Manufacturer Name sanofi pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Right Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine Rotarix
Date/Time Start of Administration 04/05/2024
Administered Amount 1
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN07
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route ORAL
Administration Site
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Rotavirus Vaccine VIS - 10/15/2021
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine Prevnar 20
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number LLBUAYMO68
Substance Expiration Date 09/27/2029
Substance Manufacturer Name sanofi pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Deltoid
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023
Date Vaccine Information Statement Presented 04/05/2024

5.1.4. 5.2.2 - Receive and process acknowledgment messages from IIS returned with an error (E)

Test Step Type: TA_RESPONDER

Test Story

Description

SUT is able to receive and process acknowledgment messages from an IIS that indicate an error was found during the course of processing the patient immunization record. The IIS has a mapping error in their NDC table and is unable to recognize the NDC code sent in RXA-5 even though it is valid. The IIS is unable to identify the appropriate vaccine and will not load the vaccine data.



Pre-condition

The SUT has transmitted administered vaccine record(s).

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

An acknowledgement (ACK Z23) is received and processed by the SUT.

Go to step 5.1.1


Test Objectives

To test the ability of the SUT for Error Handling Support for a fatal error returned by the IIS, and the ability of the SUT to display and inform the end user.

See: https://repository.immregistries.org/resource/guidance-for-hl7-acknowledgement-messages-to-support-interoperability/



Evaluation Criteria

The error returned in the acknowledgement message (AE)  with an error severity of (E) is visible in the SUT, the system responsible for the content of the transmission message.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP-IIS-APP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240115083738-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID IIP-ACK-1
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE
MSA-2 Message Control ID IIP-Transmit-2

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXA
ERR-2.2 Segment Sequence 1
ERR-2.3 Field Position 5
ERR-2.4 Field Repetition 4
ERR-2.5 Component Number
ERR-2.6 Sub-Component Number
ERR-3 HL7 Error Code
ERR-3.1 Identifier 103
ERR-3.2 Text Application error
ERR-3.3 Name of Coding System HL70357
ERR-3.5 Alternate Text
ERR-3.6 Name of Alternate Coding System
ERR-4 Severity E
ERR-5 Application Error Code
ERR-5.1 Identifier 5
ERR-5.2 Text Table value not found
ERR-5.3 Name of Coding System HL70533
ERR-5.5 Alternate Text Fields conflict
ERR-5.6 Name of Alternate Coding System L
ERR-8 User Message NDC not recognized - data was not saved.

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.1.5. 5.1.1 - Transmit newly recorded administered vaccine documented within the SUT to the IIS

Test Step Type: SUT_INITIATOR

Test Story

Description

The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step.

This includes four doses of newly administered vaccines.



Pre-condition

Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0.

Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users. This was performed in Test Step 3.6.1.

Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1.

Daniela Jennifer Wyatt is the practitioner.



Post-Condition

The newly administered vaccine doses are visible in the SUT and the IIS.

Go to the Step 5.2.1 and then repeat the transmit 5.1.1 to receive and process the additional ACKs with issues to be processed by the SUT.


Test Objectives

To test the ability that the SUT is able to send newly administration vaccine doses to the IIS.


The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Both NDC and CVX are required for new immunizations and CVX is required for historical.


Support for mother's maiden name, patient full middle name, next of kin, next of kin full middle name.


Support for both phone number and email of patient and first next of kin.


Support for patient consent


Support for VIS, funding source and VFC data

Support for Telecommunication Equipment Type


Evaluation Criteria

The IIS received a single VXU message with multiple RXA segments from the SUT containing newly administered vaccine doses recorded in the SUT.

The IIS received a single VXU message with multiple OBX segments from the SUT containing VFC eligibility for the newly administered vaccine doses recorded in the SUT.

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22).  The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

The VXU content should match the information displayed below: (DOB and actual dates of administration must be present but are not evaluated)

This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.

Patient Information
ElementData
Patient NameLance Gaige Duncan, Jr.
Mother s Maiden NameKing
ID Number1111
Date/Time of BirthUse the HIMSS IIP Test Plan v11.0 Job Aid
Today (day of test) the patient is 0 years, 1 months, and 17 days old
Administrative SexMale
Patient Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone = CP)
E-mail AddressIIPMP@gmail.com
RaceAmerican Indian or Alaska Native
Ethnic GroupNot Hispanic or Latino
Multiple Birth IndicatorNo
Birth Order1


Immunization Registry Information
ElementData
Immunization Registry StatusActive
Immunization Registry Status Effective DatePatient DOB from Job Aid
Publicity CodeReminder/recall - any method
Publicity Code Effective DateToday's date
Protection IndicatorNo
Protection Indicator Effective DateToday's date


Guardian or Responsible Party - 1
ElementData
NameIngrid Stacy Duncan
RelationshipMother
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone = CP)
E-mail AddressIIPMP@gmail.com


Guardian or Responsible Party - 2
ElementData
NameSimon Isaiah Duncan, Sr
RelationshipFather
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1233 (Cellular Phone = CP)




Vaccine Administration Information -1
ElementData
Administered VaccinePEDIARIX
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN01
Substance Expiration Date9/27/2029
Substance Manufacturer NameGlaxoSmithKline
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeMulti Pediatric Vaccines VIS - 7/24/2023
Date VIS PresentedToday's date


Vaccine Administration Information - 2
ElementData
Administered VaccineActHIB
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN05
Substance Expiration Date09/27/2029
Substance Manufacturer Namesanofi pasteur
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteRight Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeHaemophilus Influenzae type b (Hib) Vaccine VIS
Date VIS PresentedToday's date


Vaccine Administration Information - 3
ElementData
Administered VaccineRotarix
Date/Time Start of AdministrationToday's date
Administered Amount1
Administered UnitsmL
Administration NotesNew immunization record
Administering Provider
Substance Lot NumberIIPVAXN07
Substance Expiration Date09/27/2029
Substance Manufacturer NameGlaxoSmithKline
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteORAL
Administration SiteN/A
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeHaemophilus Influenzae type b (Hib) Vaccine VIS
Date VIS PresentedToday's date


Vaccine Administration Information - 4
ElementData
Administered VaccinePrevnar 20
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberLLBUAYMO68
Substance Expiration Date09/27/2029
Substance Manufacturer NamePfizer, Inc
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Deltoid
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypePneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS
Date VIS PresentedToday's date



Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html


Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405131011-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID IIP-Transmit-1 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Profile Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 1111 Presence-Content Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID IIP-MPI-1 Presence-Content Indifferent
PID-3.4.2 Universal ID
PID-3.4.3 Universal ID Type
PID-3.5 Identifier Type Code MR Value-Test Case Fixed
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Duncan Value-Test Case Fixed
PID-5.2 Given Name Lance Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Gaige Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname King Value-Test Case Fixed
PID-6.2 Given Name
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20240215 Presence-Content Indifferent
PID-8 Administrative Sex M Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 1002-5 Value-Test Case Fixed
PID-10.2 Text American Indian or Alaska Native Presence-Test Case Proper
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.4 Alternate Identifier
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
PID-11.2 Other Designation Unit A Value-Test Case Fixed
PID-11.3 City Springfield Value-Test Case Fixed
PID-11.4 State or Province OR Value-Test Case Fixed
PID-11.5 Zip or Postal Code 97477 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type P Value-Test Case Fixed
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13[1].4 Email Address
PID-13[1].6 Area/City Code 541 Value-Test Case Fixed
PID-13[1].7 Local Number 5551111 Value-Test Case Fixed
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
PID-13[2].4 Email Address IIPMP@gmail.com Value-Test Case Fixed
PID-13[2].6 Area/City Code
PID-13[2].7 Local Number
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Value-Test Case Fixed
PID-22.2 Text Not Hispanic or Latino Presence-Test Case Proper
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.4 Alternate Identifier
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator N Value-Test Case Fixed

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - any method Presence-Test Case Proper
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-11.4 Alternate Identifier
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20240405 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20240126 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20240405 Presence-Content Indifferent

NK1[*]
NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Ingrid Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Stacy Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Value-Test Case Fixed
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5[1] Phone Number
NK1-5[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5[1].4 Email Address
NK1-5[1].6 Area/City Code 541 Value-Test Case Fixed
NK1-5[1].7 Local Number 5551111 Value-Test Case Fixed
NK1-5[2] Phone Number
NK1-5[2].2 Telecommunication Use Code NET Value-Test Case Fixed
NK1-5[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
NK1-5[2].4 Email Address IIPMP@gmail.com Value-Test Case Fixed
NK1-5[2].6 Area/City Code
NK1-5[2].7 Local Number

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 2 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Simon Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Isaiah Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier FTH Value-Test Case Fixed
NK1-3.2 Text Father Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Value-Test Case Fixed
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 541 Value-Test Case Fixed
NK1-5.7 Local Number 5551233 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1111 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2222 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1112 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2223 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1113 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2224 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1114 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2225 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0811-43 Value-Test Case Fixed
RXA-5.2 Text PEDIARIX Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 110 Value-Test Case Fixed
RXA-5.5 Alternate Text DTaP-Hep B-IPV Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN01 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 49281-0547-58 Value-Test Case Fixed
RXA-5.2 Text ActHIB Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 48 Value-Test Case Fixed
RXA-5.5 Alternate Text ActHIB Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN05 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text sanofi pasteur Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0740-02 Value-Test Case Fixed
RXA-5.2 Text Rotarix Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 119 Value-Test Case Fixed
RXA-5.5 Alternate Text rotavirus, monovalent Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 1 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN07 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00005-2000-01 Value-Test Case Fixed
RXA-5.2 Text Prevnar 20 Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 216 Value-Test Case Fixed
RXA-5.5 Alternate Text Pneumococcal conjugate PCV20, polysaccharide CRM197 conjugate, adjuvant, PF Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number LLBUAYMO68 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text sanofi pasteur Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LVL Value-Test Case Fixed
RXR-2.2 Text Left Vastus Lateralis Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier RVL Value-Test Case Fixed
RXR-2.2 Text Right Vastus Lateralis Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288 Value-Test Case Fixed
RXR-1.2 Text ORAL Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300026411230724 Value-Test Case Fixed
OBX-5.2 Text Multi Pediatric Vaccines VIS - 07/24/2023 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300006611210806 Value-Test Case Fixed
OBX-5.2 Text Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300019611211015 Value-Test Case Fixed
OBX-5.2 Text Rotavirus Vaccine VIS - 10/15/2021 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300049311230512 Value-Test Case Fixed
OBX-5.2 Text Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Lance Gaige Duncan
Mother's Maiden Name King
ID Number 1111
Date/Time of Birth 02/15/2024
Administrative Sex Male
Patient Address 749 Evergreen Ter. Springfield OR 97477 USA
Local Number (541)555-1111
Email IIPMP@gmail.com
Race American Indian or Alaska Native
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator No
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 01/26/2024
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 04/05/2024
Protection Indicator No
Protection Indicator Effective Date 04/05/2024
Guardian or Responsible Party[*]
Guardian or Responsible Party
Element Data
Name Ingrid Stacy Duncan
Relationship Mother
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1111
Phone Number

Guardian or Responsible Party
Element Data
Name Simon Isaiah Duncan
Relationship Father
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1233

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine PEDIARIX
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN01
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Multi Pediatric Vaccines VIS - 07/24/2023
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine ActHIB
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN05
Substance Expiration Date 09/27/2029
Substance Manufacturer Name sanofi pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Right Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine Rotarix
Date/Time Start of Administration 04/05/2024
Administered Amount 1
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN07
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route ORAL
Administration Site
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Rotavirus Vaccine VIS - 10/15/2021
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine Prevnar 20
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number LLBUAYMO68
Substance Expiration Date 09/27/2029
Substance Manufacturer Name sanofi pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Deltoid
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023
Date Vaccine Information Statement Presented 04/05/2024

5.1.6. 5.2.3 - Receive and process acknowledgment messages from IIS returned with an warning (W)

Test Step Type: TA_RESPONDER

Test Story

Description

SUT is able to Receive and process acknowledgment messages from an IIS that indicate a warning was found during the course of processing the patient immunization record.  A mapping error in the IIS software results in the IIS being unable to recognize the administration sites sent in RXR-2 even though it is valid. The acknowledgement message returned contains a warning for an invalid value, the message was accepted but the value will not be saved.



Pre-condition

The SUT has transmitted administered vaccine.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

An acknowledgement (ACK Z23) is received and processed by the SUT.

Go to step 5.1.1


Test Objectives

To test the ability of the SUT for Error Handling Support for a warning returned by the IIS, and the ability of the SUT to display and inform the end user.

See: https://repository.immregistries.org/resource/guidance-for-hl7-acknowledgement-messages-to-support-interoperability/



Evaluation Criteria

The warning returned in the acknowledgment message (AE)with an error severity of (W) is visible in the SUT, the system responsible for the content of the transmission message.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240115083738-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID IIP-ACK-1
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE
MSA-2 Message Control ID IIP-Transmit-4

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR
ERR-2.2 Segment Sequence 2
ERR-2.3 Field Position 1
ERR-2.4 Field Repetition 1
ERR-2.5 Component Number
ERR-2.6 Sub-Component Number
ERR-3 HL7 Error Code
ERR-3.1 Identifier 103
ERR-3.2 Text Table value not found
ERR-3.3 Name of Coding System HL70357
ERR-3.5 Alternate Text
ERR-3.6 Name of Alternate Coding System
ERR-4 Severity W
ERR-5 Application Error Code
ERR-5.1 Identifier 5
ERR-5.2 Text Table value not found
ERR-5.3 Name of Coding System HL70533
ERR-5.5 Alternate Text Fields conflict
ERR-5.6 Name of Alternate Coding System L
ERR-8 User Message Administration Site not recognized - site data will not be saved

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.1.7. 5.1.1 - Transmit newly recorded administered vaccine documented within the SUT to the IIS

Test Step Type: SUT_INITIATOR

Test Story

Description

The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step.

This includes four doses of newly administered vaccines.



Pre-condition

Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0.

Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users. This was performed in Test Step 3.6.1.

Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1.

Daniela Jennifer Wyatt is the practitioner.



Post-Condition

The newly administered vaccine doses are visible in the SUT and the IIS.

Go to the Step 5.2.1 and then repeat the transmit 5.1.1 to receive and process the additional ACKs with issues to be processed by the SUT.


Test Objectives

To test the ability that the SUT is able to send newly administration vaccine doses to the IIS.


The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Both NDC and CVX are required for new immunizations and CVX is required for historical.


Support for mother's maiden name, patient full middle name, next of kin, next of kin full middle name.


Support for both phone number and email of patient and first next of kin.


Support for patient consent


Support for VIS, funding source and VFC data

Support for Telecommunication Equipment Type


Evaluation Criteria

The IIS received a single VXU message with multiple RXA segments from the SUT containing newly administered vaccine doses recorded in the SUT.

The IIS received a single VXU message with multiple OBX segments from the SUT containing VFC eligibility for the newly administered vaccine doses recorded in the SUT.

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22).  The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

The VXU content should match the information displayed below: (DOB and actual dates of administration must be present but are not evaluated)

This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.

Patient Information
ElementData
Patient NameLance Gaige Duncan, Jr.
Mother s Maiden NameKing
ID Number1111
Date/Time of BirthUse the HIMSS IIP Test Plan v11.0 Job Aid
Today (day of test) the patient is 0 years, 1 months, and 17 days old
Administrative SexMale
Patient Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone = CP)
E-mail AddressIIPMP@gmail.com
RaceAmerican Indian or Alaska Native
Ethnic GroupNot Hispanic or Latino
Multiple Birth IndicatorNo
Birth Order1


Immunization Registry Information
ElementData
Immunization Registry StatusActive
Immunization Registry Status Effective DatePatient DOB from Job Aid
Publicity CodeReminder/recall - any method
Publicity Code Effective DateToday's date
Protection IndicatorNo
Protection Indicator Effective DateToday's date


Guardian or Responsible Party - 1
ElementData
NameIngrid Stacy Duncan
RelationshipMother
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone = CP)
E-mail AddressIIPMP@gmail.com


Guardian or Responsible Party - 2
ElementData
NameSimon Isaiah Duncan, Sr
RelationshipFather
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1233 (Cellular Phone = CP)




Vaccine Administration Information -1
ElementData
Administered VaccinePEDIARIX
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN01
Substance Expiration Date9/27/2029
Substance Manufacturer NameGlaxoSmithKline
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeMulti Pediatric Vaccines VIS - 7/24/2023
Date VIS PresentedToday's date


Vaccine Administration Information - 2
ElementData
Administered VaccineActHIB
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN05
Substance Expiration Date09/27/2029
Substance Manufacturer Namesanofi pasteur
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteRight Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeHaemophilus Influenzae type b (Hib) Vaccine VIS
Date VIS PresentedToday's date


Vaccine Administration Information - 3
ElementData
Administered VaccineRotarix
Date/Time Start of AdministrationToday's date
Administered Amount1
Administered UnitsmL
Administration NotesNew immunization record
Administering Provider
Substance Lot NumberIIPVAXN07
Substance Expiration Date09/27/2029
Substance Manufacturer NameGlaxoSmithKline
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteORAL
Administration SiteN/A
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeHaemophilus Influenzae type b (Hib) Vaccine VIS
Date VIS PresentedToday's date


Vaccine Administration Information - 4
ElementData
Administered VaccinePrevnar 20
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberLLBUAYMO68
Substance Expiration Date09/27/2029
Substance Manufacturer NamePfizer, Inc
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Deltoid
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypePneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS
Date VIS PresentedToday's date



Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html


Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405131011-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID IIP-Transmit-1 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Profile Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 1111 Presence-Content Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID IIP-MPI-1 Presence-Content Indifferent
PID-3.4.2 Universal ID
PID-3.4.3 Universal ID Type
PID-3.5 Identifier Type Code MR Value-Test Case Fixed
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Duncan Value-Test Case Fixed
PID-5.2 Given Name Lance Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Gaige Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname King Value-Test Case Fixed
PID-6.2 Given Name
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20240215 Presence-Content Indifferent
PID-8 Administrative Sex M Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 1002-5 Value-Test Case Fixed
PID-10.2 Text American Indian or Alaska Native Presence-Test Case Proper
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.4 Alternate Identifier
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
PID-11.2 Other Designation Unit A Value-Test Case Fixed
PID-11.3 City Springfield Value-Test Case Fixed
PID-11.4 State or Province OR Value-Test Case Fixed
PID-11.5 Zip or Postal Code 97477 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type P Value-Test Case Fixed
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13[1].4 Email Address
PID-13[1].6 Area/City Code 541 Value-Test Case Fixed
PID-13[1].7 Local Number 5551111 Value-Test Case Fixed
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
PID-13[2].4 Email Address IIPMP@gmail.com Value-Test Case Fixed
PID-13[2].6 Area/City Code
PID-13[2].7 Local Number
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Value-Test Case Fixed
PID-22.2 Text Not Hispanic or Latino Presence-Test Case Proper
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.4 Alternate Identifier
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator N Value-Test Case Fixed

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - any method Presence-Test Case Proper
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-11.4 Alternate Identifier
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20240405 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20240126 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20240405 Presence-Content Indifferent

NK1[*]
NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Ingrid Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Stacy Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Value-Test Case Fixed
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5[1] Phone Number
NK1-5[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5[1].4 Email Address
NK1-5[1].6 Area/City Code 541 Value-Test Case Fixed
NK1-5[1].7 Local Number 5551111 Value-Test Case Fixed
NK1-5[2] Phone Number
NK1-5[2].2 Telecommunication Use Code NET Value-Test Case Fixed
NK1-5[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
NK1-5[2].4 Email Address IIPMP@gmail.com Value-Test Case Fixed
NK1-5[2].6 Area/City Code
NK1-5[2].7 Local Number

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 2 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Simon Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Isaiah Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier FTH Value-Test Case Fixed
NK1-3.2 Text Father Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Value-Test Case Fixed
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 541 Value-Test Case Fixed
NK1-5.7 Local Number 5551233 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1111 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2222 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1112 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2223 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1113 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2224 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1114 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2225 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0811-43 Value-Test Case Fixed
RXA-5.2 Text PEDIARIX Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 110 Value-Test Case Fixed
RXA-5.5 Alternate Text DTaP-Hep B-IPV Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN01 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 49281-0547-58 Value-Test Case Fixed
RXA-5.2 Text ActHIB Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 48 Value-Test Case Fixed
RXA-5.5 Alternate Text ActHIB Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN05 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text sanofi pasteur Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0740-02 Value-Test Case Fixed
RXA-5.2 Text Rotarix Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 119 Value-Test Case Fixed
RXA-5.5 Alternate Text rotavirus, monovalent Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 1 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN07 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00005-2000-01 Value-Test Case Fixed
RXA-5.2 Text Prevnar 20 Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 216 Value-Test Case Fixed
RXA-5.5 Alternate Text Pneumococcal conjugate PCV20, polysaccharide CRM197 conjugate, adjuvant, PF Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number LLBUAYMO68 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text sanofi pasteur Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LVL Value-Test Case Fixed
RXR-2.2 Text Left Vastus Lateralis Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier RVL Value-Test Case Fixed
RXR-2.2 Text Right Vastus Lateralis Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288 Value-Test Case Fixed
RXR-1.2 Text ORAL Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300026411230724 Value-Test Case Fixed
OBX-5.2 Text Multi Pediatric Vaccines VIS - 07/24/2023 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300006611210806 Value-Test Case Fixed
OBX-5.2 Text Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300019611211015 Value-Test Case Fixed
OBX-5.2 Text Rotavirus Vaccine VIS - 10/15/2021 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300049311230512 Value-Test Case Fixed
OBX-5.2 Text Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Lance Gaige Duncan
Mother's Maiden Name King
ID Number 1111
Date/Time of Birth 02/15/2024
Administrative Sex Male
Patient Address 749 Evergreen Ter. Springfield OR 97477 USA
Local Number (541)555-1111
Email IIPMP@gmail.com
Race American Indian or Alaska Native
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator No
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 01/26/2024
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 04/05/2024
Protection Indicator No
Protection Indicator Effective Date 04/05/2024
Guardian or Responsible Party[*]
Guardian or Responsible Party
Element Data
Name Ingrid Stacy Duncan
Relationship Mother
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1111
Phone Number

Guardian or Responsible Party
Element Data
Name Simon Isaiah Duncan
Relationship Father
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1233

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine PEDIARIX
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN01
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Multi Pediatric Vaccines VIS - 07/24/2023
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine ActHIB
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN05
Substance Expiration Date 09/27/2029
Substance Manufacturer Name sanofi pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Right Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine Rotarix
Date/Time Start of Administration 04/05/2024
Administered Amount 1
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN07
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route ORAL
Administration Site
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Rotavirus Vaccine VIS - 10/15/2021
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine Prevnar 20
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number LLBUAYMO68
Substance Expiration Date 09/27/2029
Substance Manufacturer Name sanofi pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Deltoid
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023
Date Vaccine Information Statement Presented 04/05/2024

5.1.8. 5.2.4 - Receive and process acknowledgment messages from IIS returned with an informational warning (I)

Test Step Type: TA_RESPONDER

Test Story

Description

SUT is able to receive and process acknowledgment messages from an IIS that indicate an informational warning was found during the course of processing the patient immunization record. A mapping error in the IIS software results in the IIS being unable to recognize the patient's county. The message was accepted but the value will not be saved.



Pre-condition

The SUT has transmitted administered vaccine.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

An acknowledgement (ACK Z23) is received and processed by the SUT.

Go to step 5.1.1


Test Objectives

To test the ability of the SUT for Error Handling Support for an informational warning returned by the IIS, and the ability of the SUT to display and inform the end user.

See: https://repository.immregistries.org/resource/guidance-for-hl7-acknowledgement-messages-to-support-interoperability/



Evaluation Criteria

The informational warning returned in the acknowledgment message (AA) with an error severity of (I) is visible in the SUT, the system responsible for the content of the transmission message.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240115083738-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID IIP-ACK-1
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID IIP-Transmit-3

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID PID
ERR-2.2 Segment Sequence 11
ERR-2.3 Field Position 9
ERR-2.4 Field Repetition 1
ERR-2.5 Component Number
ERR-2.6 Sub-Component Number
ERR-3 HL7 Error Code
ERR-3.1 Identifier 103
ERR-3.2 Text Table value not found
ERR-3.3 Name of Coding System HL70357
ERR-3.5 Alternate Text
ERR-3.6 Name of Alternate Coding System
ERR-4 Severity I
ERR-5 Application Error Code
ERR-5.1 Identifier 5
ERR-5.2 Text Application internal error
ERR-5.3 Name of Coding System HL70533
ERR-5.5 Alternate Text Fields conflict
ERR-5.6 Name of Alternate Coding System L
ERR-8 User Message IIS Mapping Error - County Code will not load

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.1.9. 5.1.1 - Transmit newly recorded administered vaccine documented within the SUT to the IIS

Test Step Type: SUT_INITIATOR

Test Story

Description

The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step.

This includes four doses of newly administered vaccines.



Pre-condition

Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0.

Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users. This was performed in Test Step 3.6.1.

Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1.

Daniela Jennifer Wyatt is the practitioner.



Post-Condition

The newly administered vaccine doses are visible in the SUT and the IIS.

Go to the Step 5.2.1 and then repeat the transmit 5.1.1 to receive and process the additional ACKs with issues to be processed by the SUT.


Test Objectives

To test the ability that the SUT is able to send newly administration vaccine doses to the IIS.


The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Both NDC and CVX are required for new immunizations and CVX is required for historical.


Support for mother's maiden name, patient full middle name, next of kin, next of kin full middle name.


Support for both phone number and email of patient and first next of kin.


Support for patient consent


Support for VIS, funding source and VFC data

Support for Telecommunication Equipment Type


Evaluation Criteria

The IIS received a single VXU message with multiple RXA segments from the SUT containing newly administered vaccine doses recorded in the SUT.

The IIS received a single VXU message with multiple OBX segments from the SUT containing VFC eligibility for the newly administered vaccine doses recorded in the SUT.

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22).  The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

The VXU content should match the information displayed below: (DOB and actual dates of administration must be present but are not evaluated)

This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.

Patient Information
ElementData
Patient NameLance Gaige Duncan, Jr.
Mother s Maiden NameKing
ID Number1111
Date/Time of BirthUse the HIMSS IIP Test Plan v11.0 Job Aid
Today (day of test) the patient is 0 years, 1 months, and 17 days old
Administrative SexMale
Patient Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone = CP)
E-mail AddressIIPMP@gmail.com
RaceAmerican Indian or Alaska Native
Ethnic GroupNot Hispanic or Latino
Multiple Birth IndicatorNo
Birth Order1


Immunization Registry Information
ElementData
Immunization Registry StatusActive
Immunization Registry Status Effective DatePatient DOB from Job Aid
Publicity CodeReminder/recall - any method
Publicity Code Effective DateToday's date
Protection IndicatorNo
Protection Indicator Effective DateToday's date


Guardian or Responsible Party - 1
ElementData
NameIngrid Stacy Duncan
RelationshipMother
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone = CP)
E-mail AddressIIPMP@gmail.com


Guardian or Responsible Party - 2
ElementData
NameSimon Isaiah Duncan, Sr
RelationshipFather
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1233 (Cellular Phone = CP)




Vaccine Administration Information -1
ElementData
Administered VaccinePEDIARIX
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN01
Substance Expiration Date9/27/2029
Substance Manufacturer NameGlaxoSmithKline
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeMulti Pediatric Vaccines VIS - 7/24/2023
Date VIS PresentedToday's date


Vaccine Administration Information - 2
ElementData
Administered VaccineActHIB
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN05
Substance Expiration Date09/27/2029
Substance Manufacturer Namesanofi pasteur
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteRight Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeHaemophilus Influenzae type b (Hib) Vaccine VIS
Date VIS PresentedToday's date


Vaccine Administration Information - 3
ElementData
Administered VaccineRotarix
Date/Time Start of AdministrationToday's date
Administered Amount1
Administered UnitsmL
Administration NotesNew immunization record
Administering Provider
Substance Lot NumberIIPVAXN07
Substance Expiration Date09/27/2029
Substance Manufacturer NameGlaxoSmithKline
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteORAL
Administration SiteN/A
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeHaemophilus Influenzae type b (Hib) Vaccine VIS
Date VIS PresentedToday's date


Vaccine Administration Information - 4
ElementData
Administered VaccinePrevnar 20
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberLLBUAYMO68
Substance Expiration Date09/27/2029
Substance Manufacturer NamePfizer, Inc
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Deltoid
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypePneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS
Date VIS PresentedToday's date



Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html


Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405131011-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID IIP-Transmit-1 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Profile Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 1111 Presence-Content Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID IIP-MPI-1 Presence-Content Indifferent
PID-3.4.2 Universal ID
PID-3.4.3 Universal ID Type
PID-3.5 Identifier Type Code MR Value-Test Case Fixed
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Duncan Value-Test Case Fixed
PID-5.2 Given Name Lance Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Gaige Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname King Value-Test Case Fixed
PID-6.2 Given Name
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20240215 Presence-Content Indifferent
PID-8 Administrative Sex M Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 1002-5 Value-Test Case Fixed
PID-10.2 Text American Indian or Alaska Native Presence-Test Case Proper
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.4 Alternate Identifier
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
PID-11.2 Other Designation Unit A Value-Test Case Fixed
PID-11.3 City Springfield Value-Test Case Fixed
PID-11.4 State or Province OR Value-Test Case Fixed
PID-11.5 Zip or Postal Code 97477 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type P Value-Test Case Fixed
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13[1].4 Email Address
PID-13[1].6 Area/City Code 541 Value-Test Case Fixed
PID-13[1].7 Local Number 5551111 Value-Test Case Fixed
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
PID-13[2].4 Email Address IIPMP@gmail.com Value-Test Case Fixed
PID-13[2].6 Area/City Code
PID-13[2].7 Local Number
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Value-Test Case Fixed
PID-22.2 Text Not Hispanic or Latino Presence-Test Case Proper
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.4 Alternate Identifier
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator N Value-Test Case Fixed

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - any method Presence-Test Case Proper
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-11.4 Alternate Identifier
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20240405 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20240126 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20240405 Presence-Content Indifferent

NK1[*]
NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Ingrid Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Stacy Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Value-Test Case Fixed
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5[1] Phone Number
NK1-5[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5[1].4 Email Address
NK1-5[1].6 Area/City Code 541 Value-Test Case Fixed
NK1-5[1].7 Local Number 5551111 Value-Test Case Fixed
NK1-5[2] Phone Number
NK1-5[2].2 Telecommunication Use Code NET Value-Test Case Fixed
NK1-5[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
NK1-5[2].4 Email Address IIPMP@gmail.com Value-Test Case Fixed
NK1-5[2].6 Area/City Code
NK1-5[2].7 Local Number

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 2 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Simon Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Isaiah Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier FTH Value-Test Case Fixed
NK1-3.2 Text Father Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Value-Test Case Fixed
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 541 Value-Test Case Fixed
NK1-5.7 Local Number 5551233 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1111 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2222 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1112 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2223 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1113 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2224 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1114 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2225 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0811-43 Value-Test Case Fixed
RXA-5.2 Text PEDIARIX Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 110 Value-Test Case Fixed
RXA-5.5 Alternate Text DTaP-Hep B-IPV Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN01 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 49281-0547-58 Value-Test Case Fixed
RXA-5.2 Text ActHIB Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 48 Value-Test Case Fixed
RXA-5.5 Alternate Text ActHIB Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN05 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text sanofi pasteur Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0740-02 Value-Test Case Fixed
RXA-5.2 Text Rotarix Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 119 Value-Test Case Fixed
RXA-5.5 Alternate Text rotavirus, monovalent Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 1 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN07 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00005-2000-01 Value-Test Case Fixed
RXA-5.2 Text Prevnar 20 Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 216 Value-Test Case Fixed
RXA-5.5 Alternate Text Pneumococcal conjugate PCV20, polysaccharide CRM197 conjugate, adjuvant, PF Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number LLBUAYMO68 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text sanofi pasteur Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LVL Value-Test Case Fixed
RXR-2.2 Text Left Vastus Lateralis Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier RVL Value-Test Case Fixed
RXR-2.2 Text Right Vastus Lateralis Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288 Value-Test Case Fixed
RXR-1.2 Text ORAL Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300026411230724 Value-Test Case Fixed
OBX-5.2 Text Multi Pediatric Vaccines VIS - 07/24/2023 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300006611210806 Value-Test Case Fixed
OBX-5.2 Text Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300019611211015 Value-Test Case Fixed
OBX-5.2 Text Rotavirus Vaccine VIS - 10/15/2021 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300049311230512 Value-Test Case Fixed
OBX-5.2 Text Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Lance Gaige Duncan
Mother's Maiden Name King
ID Number 1111
Date/Time of Birth 02/15/2024
Administrative Sex Male
Patient Address 749 Evergreen Ter. Springfield OR 97477 USA
Local Number (541)555-1111
Email IIPMP@gmail.com
Race American Indian or Alaska Native
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator No
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 01/26/2024
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 04/05/2024
Protection Indicator No
Protection Indicator Effective Date 04/05/2024
Guardian or Responsible Party[*]
Guardian or Responsible Party
Element Data
Name Ingrid Stacy Duncan
Relationship Mother
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1111
Phone Number

Guardian or Responsible Party
Element Data
Name Simon Isaiah Duncan
Relationship Father
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1233

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine PEDIARIX
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN01
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Multi Pediatric Vaccines VIS - 07/24/2023
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine ActHIB
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN05
Substance Expiration Date 09/27/2029
Substance Manufacturer Name sanofi pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Right Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine Rotarix
Date/Time Start of Administration 04/05/2024
Administered Amount 1
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN07
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route ORAL
Administration Site
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Rotavirus Vaccine VIS - 10/15/2021
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine Prevnar 20
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number LLBUAYMO68
Substance Expiration Date 09/27/2029
Substance Manufacturer Name sanofi pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Deltoid
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023
Date Vaccine Information Statement Presented 04/05/2024

5.1.10. 5.2.5 - Receive and process acknowledgment messages from IIS returned with multiple warnings (W)

Test Step Type: TA_RESPONDER

Test Story

Description

SUT is able to receive and process acknowledgment messages from an IIS that indicate multiple warnings were found during the course of processing the patient immunization record. A mapping error in the IIS software results in the IIS being unable to recognize the administration route and site sent in the associated RXR-1 and RXR 2 segments even though they are valid. The acknowledgment message returned contains warnings for an invalid value. The message was accepted but the value will not be saved.



Pre-condition

The SUT has transmitted two administered vaccines.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

An acknowledgement (ACK Z23) is received and processed by the SUT.

Go to step 5.1.1


Test Objectives

To test the ability of the SUT for Error Handling Support for multiple warnings returned by the IIS, and the ability of the SUT to display and inform the end user.

See: https://repository.immregistries.org/resource/guidance-for-hl7-acknowledgement-messages-to-support-interoperability/



Evaluation Criteria

The two warnings returned in the acknowledgment message (AE) with an error severity of (W) are visible in the SUT, the system responsible for the content of the transmission message.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240115083738-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID IIP-ACK-1
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE
MSA-2 Message Control ID IIP-Transmit-5

ERR[*]
ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR
ERR-2.2 Segment Sequence 1
ERR-2.3 Field Position 1
ERR-2.4 Field Repetition 1
ERR-2.5 Component Number
ERR-2.6 Sub-Component Number
ERR-3 HL7 Error Code
ERR-3.1 Identifier 103
ERR-3.2 Text Table value not found
ERR-3.3 Name of Coding System HL70357
ERR-3.5 Alternate Text
ERR-3.6 Name of Alternate Coding System
ERR-4 Severity W
ERR-5 Application Error Code
ERR-5.1 Identifier 5
ERR-5.2 Text Table value not found
ERR-5.3 Name of Coding System HL70533
ERR-5.5 Alternate Text Fields conflict
ERR-5.6 Name of Alternate Coding System L
ERR-8 User Message Administration Route not recognized - data will not be saved

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR
ERR-2.2 Segment Sequence 2
ERR-2.3 Field Position 1
ERR-2.4 Field Repetition 1
ERR-2.5 Component Number
ERR-2.6 Sub-Component Number
ERR-3 HL7 Error Code
ERR-3.1 Identifier 103
ERR-3.2 Text Table value not found
ERR-3.3 Name of Coding System HL70357
ERR-3.5 Alternate Text
ERR-3.6 Name of Alternate Coding System
ERR-4 Severity W
ERR-5 Application Error Code
ERR-5.1 Identifier 5
ERR-5.2 Text Table value not found
ERR-5.3 Name of Coding System HL70533
ERR-5.5 Alternate Text Fields conflict
ERR-5.6 Name of Alternate Coding System L
ERR-8 User Message Administration Site not recognized - site data will not be saved

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.1.11. 5.1.1 - Transmit newly recorded administered vaccine documented within the SUT to the IIS

Test Step Type: SUT_INITIATOR

Test Story

Description

The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step.

This includes four doses of newly administered vaccines.



Pre-condition

Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0.

Lance Gaige Duncan Jr. administered doses with 2D barcodes (PEDIARIX, Rotarix, and ActHIB) have been recorded in the SUT and are visible to SUT users. This was performed in Test Step 3.6.1.

Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1.

Daniela Jennifer Wyatt is the practitioner.



Post-Condition

The newly administered vaccine doses are visible in the SUT and the IIS.

Go to the Step 5.2.1 and then repeat the transmit 5.1.1 to receive and process the additional ACKs with issues to be processed by the SUT.


Test Objectives

To test the ability that the SUT is able to send newly administration vaccine doses to the IIS.


The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Both NDC and CVX are required for new immunizations and CVX is required for historical.


Support for mother's maiden name, patient full middle name, next of kin, next of kin full middle name.


Support for both phone number and email of patient and first next of kin.


Support for patient consent


Support for VIS, funding source and VFC data

Support for Telecommunication Equipment Type


Evaluation Criteria

The IIS received a single VXU message with multiple RXA segments from the SUT containing newly administered vaccine doses recorded in the SUT.

The IIS received a single VXU message with multiple OBX segments from the SUT containing VFC eligibility for the newly administered vaccine doses recorded in the SUT.

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22).  The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

The VXU content should match the information displayed below: (DOB and actual dates of administration must be present but are not evaluated)

This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.

Patient Information
ElementData
Patient NameLance Gaige Duncan, Jr.
Mother s Maiden NameKing
ID Number1111
Date/Time of BirthUse the HIMSS IIP Test Plan v11.0 Job Aid
Today (day of test) the patient is 0 years, 1 months, and 17 days old
Administrative SexMale
Patient Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone = CP)
E-mail AddressIIPMP@gmail.com
RaceAmerican Indian or Alaska Native
Ethnic GroupNot Hispanic or Latino
Multiple Birth IndicatorNo
Birth Order1


Immunization Registry Information
ElementData
Immunization Registry StatusActive
Immunization Registry Status Effective DatePatient DOB from Job Aid
Publicity CodeReminder/recall - any method
Publicity Code Effective DateToday's date
Protection IndicatorNo
Protection Indicator Effective DateToday's date


Guardian or Responsible Party - 1
ElementData
NameIngrid Stacy Duncan
RelationshipMother
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone = CP)
E-mail AddressIIPMP@gmail.com


Guardian or Responsible Party - 2
ElementData
NameSimon Isaiah Duncan, Sr
RelationshipFather
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1233 (Cellular Phone = CP)




Vaccine Administration Information -1
ElementData
Administered VaccinePEDIARIX
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN01
Substance Expiration Date9/27/2029
Substance Manufacturer NameGlaxoSmithKline
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeMulti Pediatric Vaccines VIS - 7/24/2023
Date VIS PresentedToday's date


Vaccine Administration Information - 2
ElementData
Administered VaccineActHIB
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN05
Substance Expiration Date09/27/2029
Substance Manufacturer Namesanofi pasteur
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteRight Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeHaemophilus Influenzae type b (Hib) Vaccine VIS
Date VIS PresentedToday's date


Vaccine Administration Information - 3
ElementData
Administered VaccineRotarix
Date/Time Start of AdministrationToday's date
Administered Amount1
Administered UnitsmL
Administration NotesNew immunization record
Administering Provider
Substance Lot NumberIIPVAXN07
Substance Expiration Date09/27/2029
Substance Manufacturer NameGlaxoSmithKline
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteORAL
Administration SiteN/A
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypeHaemophilus Influenzae type b (Hib) Vaccine VIS
Date VIS PresentedToday's date


Vaccine Administration Information - 4
ElementData
Administered VaccinePrevnar 20
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberLLBUAYMO68
Substance Expiration Date09/27/2029
Substance Manufacturer NamePfizer, Inc
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Deltoid
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypePneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS
Date VIS PresentedToday's date



Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html


Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405131011-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID IIP-Transmit-1 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Profile Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 1111 Presence-Content Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID IIP-MPI-1 Presence-Content Indifferent
PID-3.4.2 Universal ID
PID-3.4.3 Universal ID Type
PID-3.5 Identifier Type Code MR Value-Test Case Fixed
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Duncan Value-Test Case Fixed
PID-5.2 Given Name Lance Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Gaige Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname King Value-Test Case Fixed
PID-6.2 Given Name
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20240215 Presence-Content Indifferent
PID-8 Administrative Sex M Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 1002-5 Value-Test Case Fixed
PID-10.2 Text American Indian or Alaska Native Presence-Test Case Proper
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.4 Alternate Identifier
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
PID-11.2 Other Designation Unit A Value-Test Case Fixed
PID-11.3 City Springfield Value-Test Case Fixed
PID-11.4 State or Province OR Value-Test Case Fixed
PID-11.5 Zip or Postal Code 97477 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type P Value-Test Case Fixed
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13[1].4 Email Address
PID-13[1].6 Area/City Code 541 Value-Test Case Fixed
PID-13[1].7 Local Number 5551111 Value-Test Case Fixed
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
PID-13[2].4 Email Address IIPMP@gmail.com Value-Test Case Fixed
PID-13[2].6 Area/City Code
PID-13[2].7 Local Number
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Value-Test Case Fixed
PID-22.2 Text Not Hispanic or Latino Presence-Test Case Proper
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.4 Alternate Identifier
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator N Value-Test Case Fixed

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - any method Presence-Test Case Proper
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-11.4 Alternate Identifier
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20240405 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20240126 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20240405 Presence-Content Indifferent

NK1[*]
NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Ingrid Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Stacy Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Value-Test Case Fixed
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5[1] Phone Number
NK1-5[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5[1].4 Email Address
NK1-5[1].6 Area/City Code 541 Value-Test Case Fixed
NK1-5[1].7 Local Number 5551111 Value-Test Case Fixed
NK1-5[2] Phone Number
NK1-5[2].2 Telecommunication Use Code NET Value-Test Case Fixed
NK1-5[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
NK1-5[2].4 Email Address IIPMP@gmail.com Value-Test Case Fixed
NK1-5[2].6 Area/City Code
NK1-5[2].7 Local Number

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 2 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Simon Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Isaiah Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier FTH Value-Test Case Fixed
NK1-3.2 Text Father Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Value-Test Case Fixed
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 541 Value-Test Case Fixed
NK1-5.7 Local Number 5551233 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1111 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2222 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1112 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2223 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1113 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2224 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1114 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2225 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0811-43 Value-Test Case Fixed
RXA-5.2 Text PEDIARIX Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 110 Value-Test Case Fixed
RXA-5.5 Alternate Text DTaP-Hep B-IPV Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN01 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 49281-0547-58 Value-Test Case Fixed
RXA-5.2 Text ActHIB Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 48 Value-Test Case Fixed
RXA-5.5 Alternate Text ActHIB Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN05 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text sanofi pasteur Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0740-02 Value-Test Case Fixed
RXA-5.2 Text Rotarix Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 119 Value-Test Case Fixed
RXA-5.5 Alternate Text rotavirus, monovalent Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 1 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN07 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00005-2000-01 Value-Test Case Fixed
RXA-5.2 Text Prevnar 20 Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 216 Value-Test Case Fixed
RXA-5.5 Alternate Text Pneumococcal conjugate PCV20, polysaccharide CRM197 conjugate, adjuvant, PF Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number LLBUAYMO68 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text sanofi pasteur Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LVL Value-Test Case Fixed
RXR-2.2 Text Left Vastus Lateralis Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier RVL Value-Test Case Fixed
RXR-2.2 Text Right Vastus Lateralis Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288 Value-Test Case Fixed
RXR-1.2 Text ORAL Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300026411230724 Value-Test Case Fixed
OBX-5.2 Text Multi Pediatric Vaccines VIS - 07/24/2023 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300006611210806 Value-Test Case Fixed
OBX-5.2 Text Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300019611211015 Value-Test Case Fixed
OBX-5.2 Text Rotavirus Vaccine VIS - 10/15/2021 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300049311230512 Value-Test Case Fixed
OBX-5.2 Text Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Lance Gaige Duncan
Mother's Maiden Name King
ID Number 1111
Date/Time of Birth 02/15/2024
Administrative Sex Male
Patient Address 749 Evergreen Ter. Springfield OR 97477 USA
Local Number (541)555-1111
Email IIPMP@gmail.com
Race American Indian or Alaska Native
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator No
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 01/26/2024
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 04/05/2024
Protection Indicator No
Protection Indicator Effective Date 04/05/2024
Guardian or Responsible Party[*]
Guardian or Responsible Party
Element Data
Name Ingrid Stacy Duncan
Relationship Mother
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1111
Phone Number

Guardian or Responsible Party
Element Data
Name Simon Isaiah Duncan
Relationship Father
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1233

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine PEDIARIX
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN01
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Multi Pediatric Vaccines VIS - 07/24/2023
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine ActHIB
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN05
Substance Expiration Date 09/27/2029
Substance Manufacturer Name sanofi pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Right Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Haemophilus Influenzae type b (Hib) Vaccine VIS - 08/06/2021
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine Rotarix
Date/Time Start of Administration 04/05/2024
Administered Amount 1
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN07
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route ORAL
Administration Site
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Rotavirus Vaccine VIS - 10/15/2021
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine Prevnar 20
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number LLBUAYMO68
Substance Expiration Date 09/27/2029
Substance Manufacturer Name sanofi pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Deltoid
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023
Date Vaccine Information Statement Presented 04/05/2024

5.1.12. 5.2.6 - Receive and process acknowledgment messages from IIS returned with an error (E)

Test Step Type: TA_RESPONDER

Test Story

Description

SUT is able to receive and process acknowledgment messages from IIS, indicating a fatal system error due to the inability to process the entire message. The message was rejected, no data was saved.



Pre-condition

The SUT has transmitted administered vaccine record(s).

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

An acknowledgement (ACK Z23) is received and processed by the SUT.

Go to step 5.3.1


Test Objectives

To test the ability of the SUT for Error Handling Support for a fatal error returned by the IIS, and the ability of the SUT to display and inform the end user.

See: https://repository.immregistries.org/resource/guidance-for-hl7-acknowledgement-messages-to-support-interoperability/



Evaluation Criteria

The error returned in the acknowledgment message (AR) with an error severity of (E) is visible in the SUT, the system responsible for the content of the transmission message.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240115083738-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID IIP-ACK-1
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AR
MSA-2 Message Control ID IIP-Transmit-2

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXA
ERR-2.2 Segment Sequence 1
ERR-2.3 Field Position 5
ERR-2.4 Field Repetition 4
ERR-2.5 Component Number
ERR-2.6 Sub-Component Number
ERR-3 HL7 Error Code
ERR-3.1 Identifier 207
ERR-3.2 Text Application internal error
ERR-3.3 Name of Coding System HL70357
ERR-3.5 Alternate Text
ERR-3.6 Name of Alternate Coding System
ERR-4 Severity E
ERR-5 Application Error Code
ERR-5.1 Identifier 5
ERR-5.2 Text Unable to be processed
ERR-5.3 Name of Coding System HL70533
ERR-5.5 Alternate Text System Error
ERR-5.6 Name of Alternate Coding System L
ERR-8 User Message Message unable to be processed for reasons unrelated to format or content- message rejected

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.2. LGD 5.3.0 - Update Vaccine Record

Test Story

Description

The SUT supports the ability to send updated patient immunization records to the IIS.



Comments

Please use the job aid located here: HIMSS IIP Test Plan v11.0 Job Aid

 

Located in NIST under User Documentation


Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

Go to step 5.3.1 to transmit update to lot number


Evaluation Criteria

See test step for details.



5.2.1. 5.3.1 - Document update to vaccine record with correct lot number manually keyed within the SUT

Test Step Type: SUT_MANUAL

Test Story

Description

In Step 3.7.1 the administering practitioner manually keys in the wrong lot number. The practitioner realizes this after the vaccine record has been completed in the SUT and transmitted to IIS. The practitioner reopens the record and correctly enters the lot number of LLBUAYM06 to update the record.



Pre-condition

Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0.
Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1.
The lot number documented in the administration record for Prevnar 20 is incorrect as LLBUAYMO68

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

To test the ability that the SUT displays a corrected lot number for a newly administered vaccine dose recorded in the SUT.

The correct lot number is LLBUAYMO6

Go to step 5.3.2 to submit the update VXU from this step.


Test Objectives

To test the ability of the SUT that updates to vaccine record details are allowed in the SUT and are visible to the user.



Evaluation Criteria

The SUT is able to reopen closed vaccine records to update/modify incorrectly documented vaccine details.
The vaccine record is updated with the correct lot number using the details below:


Patient Information
ElementData
Patient NameLance Gaige Duncan, Jr.
Mother s Maiden NameKing
ID Number1111
Date/Time of BirthUse the HIMSS IIP Test Plan v11.0 Job Aid
Today (day of test) the patient is 0 years, 1 months, and 17 days old
Administrative SexMale
Patient Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone=CP)
E-mail AddressIIPMP@gmail.com
RaceAmerican Indian or Alaska Native
Ethnic GroupNot Hispanic or Latino
Multiple Birth IndicatorNo
Birth Order1


Immunization Registry Information
ElementData
Immunization Registry StatusActive
Immunization Registry Status Effective DatePatient DOB from Job Aid
Publicity CodeReminder/recall - any method
Publicity Code Effective DatePatient DOB from Job Aid
Protection IndicatorNo
Protection Indicator Effective DatePatient DOB from Job Aid


Guardian or Responsible Party - 1
ElementData
NameIngrid Stacy Duncan
RelationshipMother
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone=CP)
E-mail AddressIIPMP@gmail.com


Guardian or Responsible Party - 2
ElementData
NameSimon Isaiah Duncan Sr.
RelationshipFather
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1233 (Cellular Phone=CP)


Vaccine Administration Information - 4 update
ElementData
Administered VaccinePrevnar 20
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberLLBUAYMO6
Substance Expiration Date9/27/2029
Substance Manufacturer NamePfizer, Inc
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeUpdate
RouteINTRAMUSCULAR
Administration SiteLeft Deltoid
Entering OrganizationOregon Family Medicine
Entered ByRamon Michael Bradshaw
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypePneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS
Date VIS PresentedToday's date



Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html


5.2.2. 5.3.2 - Transmit update VXU to newly administered vaccine (previously sent) with correct lot number manually keyed, documented within the SUT to the IIS

Test Step Type: SUT_INITIATOR

Test Story

Description

In Step 3.7.1 the administering practitioner manually keys in the wrong lot number. The practitioner realizes this after the vaccine record has been completed in the SUT and transmitted to IIS. The practitioner reopens the record and correctly enters the lot number to update the record.

The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step.


Pre-condition

Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0.

Lance Gaige Duncan Jr. is administered dose without a scannable 2D barcode (Prevnar 20), it has been recorded in the SUT and is visible to SUT users. This was performed in Test Step 3.7.1.

The vaccine administration has been updated to reflect the correct lot number that was previously incorrectly typed in and submitted.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

The SUT and the IIS displays a corrected lot number for a newly administered vaccine dose recorded in the SUT.

Go to step 5.3.3 to receive and process ACK from this step.


Test Objectives

To test the ability that the SUT is able to send newly administration vaccine doses to the IIS.

The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Both NDC and CVX are required for new immunizations and CVX is required for historical.



Evaluation Criteria

The IIS received a single VXU message with an RXA segment containing an action code of "U" from the SUT for newly administered vaccine dose recorded in the SUT with an updated lot number.

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22).  The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.

Patient Information
ElementData
Patient NameLance Gaige Duncan, Jr.
Mother s Maiden NameKing
ID Number1111
Date/Time of BirthUse the HIMSS IIP Test Plan v11.0 Job Aid
Today (day of test) the patient is 0 years, 1 months, and 17 days old
Administrative SexMale
Patient Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone=CP)
E-mail AddressIIPMP@gmail.com
RaceAmerican Indian or Alaska Native
Ethnic GroupNot Hispanic or Latino
Multiple Birth IndicatorNo
Birth Order1


Immunization Registry Information
ElementData
Immunization Registry StatusActive
Immunization Registry Status Effective DatePatient DOB from Job Aid
Publicity CodeReminder/recall - any method
Publicity Code Effective DatePatient DOB from Job Aid
Protection IndicatorNo
Protection Indicator Effective DatePatient DOB from Job Aid


Guardian or Responsible Party - 1
ElementData
NameIngrid Stacy Duncan
RelationshipMother
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone=CP)
E-mail AddressIIPMP@gmail.com


Guardian or Responsible Party - 2
ElementData
NameSimon Isaiah Duncan Sr.
RelationshipFather
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1233 (Cellular Phone=CP)


Vaccine Administration Information - 4 update
ElementData
Administered VaccinePrevnar 20
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberLLBUAYMO6
Substance Expiration Date9/27/2029
Substance Manufacturer NamePfizer, Inc
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeUpdate
RouteINTRAMUSCULAR
Administration SiteLeft Deltoid
Entering OrganizationOregon Family Medicine
Entered ByRamon Michael Bradshaw
Ordered ByRamon Michael Bradshaw


Observations
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityVFC eligible - American Indian/Alaskan Native
Document TypePneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS
Date VIS PresentedToday's date



Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html


Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405111559-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID IIP-Transmit-6 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Profile Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 1111 Presence-Content Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID IIP-MPI-1 Presence-Content Indifferent
PID-3.4.2 Universal ID
PID-3.4.3 Universal ID Type
PID-3.5 Identifier Type Code MR Value-Test Case Fixed
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Duncan Value-Test Case Fixed
PID-5.2 Given Name Lance Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Gaige Presence-Content Indifferent
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname King Presence-Content Indifferent
PID-6.2 Given Name
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20240215 Presence-Content Indifferent
PID-8 Administrative Sex M Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 1002-5 Value-Test Case Fixed
PID-10.2 Text American Indian or Alaska Native Presence-Test Case Proper
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.4 Alternate Identifier
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
PID-11.2 Other Designation Unit A Value-Test Case Fixed
PID-11.3 City Springfield Value-Test Case Fixed
PID-11.4 State or Province OR Value-Test Case Fixed
PID-11.5 Zip or Postal Code 97477 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type P Value-Test Case Fixed
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13[1].4 Email Address
PID-13[1].6 Area/City Code 541 Value-Test Case Fixed
PID-13[1].7 Local Number 5551111 Value-Test Case Fixed
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
PID-13[2].4 Email Address IIPMP@gmail.com Presence-Content Indifferent
PID-13[2].6 Area/City Code
PID-13[2].7 Local Number
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Value-Test Case Fixed
PID-22.2 Text Not Hispanic or Latino Presence-Test Case Proper
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.4 Alternate Identifier
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator N

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - any method Presence-Test Case Proper
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-11.4 Alternate Identifier
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20240405 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20240126 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20240405 Presence-Content Indifferent

NK1[*]
NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Ingrid Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Stacy Presence-Content Indifferent
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Value-Test Case Fixed
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5[1] Phone Number
NK1-5[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5[1].4 Email Address
NK1-5[1].6 Area/City Code 541 Value-Test Case Fixed
NK1-5[1].7 Local Number 5551111 Value-Test Case Fixed
NK1-5[2] Phone Number
NK1-5[2].2 Telecommunication Use Code NET Value-Test Case Fixed
NK1-5[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
NK1-5[2].4 Email Address IIPMP@gmail.com Presence-Content Indifferent
NK1-5[2].6 Area/City Code
NK1-5[2].7 Local Number

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 2 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Simon Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Isaiah Presence-Content Indifferent
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier FTH Value-Test Case Fixed
NK1-3.2 Text Father Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Value-Test Case Fixed
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 541 Value-Test Case Fixed
NK1-5.7 Local Number 5551233 Value-Test Case Fixed

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1114 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2225 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00005-2000-01 Value-Test Case Fixed
RXA-5.2 Text Prevnar 20 Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 216 Value-Test Case Fixed
RXA-5.5 Alternate Text Pneumococcal conjugate PCV20, polysaccharide CRM197 conjugate, adjuvant, PF Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number LLBUAYMO6 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Value-Test Case Fixed
RXA-17.2 Text sanofi pasteur Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA U Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V04 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - American Indian/Alaskan Native Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300049311230512 Value-Test Case Fixed
OBX-5.2 Text Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Lance Gaige Duncan
Mother's Maiden Name King
ID Number 1111
Date/Time of Birth 02/15/2024
Administrative Sex Male
Patient Address 749 Evergreen Ter. Springfield OR 97477 USA
Local Number (541)555-1111
Email IIPMP@gmail.com
Race American Indian or Alaska Native
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator No
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 01/26/2024
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 04/05/2024
Protection Indicator No
Protection Indicator Effective Date 04/05/2024
Guardian or Responsible Party[*]
Guardian or Responsible Party
Element Data
Name Ingrid Stacy Duncan
Relationship Mother
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1111
Phone Number

Guardian or Responsible Party
Element Data
Name Simon Isaiah Duncan
Relationship Father
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1233

Vaccine Administration Information
Element Data
Administered Vaccine Prevnar 20
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number LLBUAYMO6
Substance Expiration Date 09/27/2029
Substance Manufacturer Name sanofi pasteur
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Update
Route INTRAMUSCULAR
Administration Site Left Deltoid
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category VFC eligible - American Indian/Alaskan Native
Document type Pneumococcal Conjugate Vaccine (PCV13_PCV15_PCV20) VIS - 05/12/2023
Date Vaccine Information Statement Presented 04/05/2024

5.2.3. 5.3.3 - Not evaluated: Receive acknowledgment messages from an IIS during the course of processing the patient immunization record

Test Step Type: TA_RESPONDER

Test Story

Description

SUT is able to Receive acknowledgment messages from an IIS during the course of processing the patient immunization record.



Pre-condition

The SUT has transmitted administered vaccine update.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

An acknowledgement (ACK Z23) is received and processed by the SUT.

Go to step 3.8.1


Test Objectives

The SUT is able to receive an acknowledgment in response to VXU transmissions.



Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.

The acknowledgment message is displayed and consumed by the SUT responsible for the content of the administration message.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405114221-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID IIP-ACK-1
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID IIP-Transmit-6

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.3. LGD 5.4.0 - Transmit newly recorded historical immunization records to IIS

Test Story

Description

The SUT supports the ability to transmit newly documented historical immunization records to the IIS.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Evaluation Criteria

See test step for details.



5.3.1. 5.4.1 - Transmit newly recorded historical vaccine documented within the SUT to the IIS

Test Step Type: SUT_INITIATOR

Test Story

Description

Supports test step 3.2.1 This includes a dose of newly recorded historical vaccine.

The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step.



Pre-condition

Lance Gaige Duncan Jr. is registered in the SUT. This was performed in Test Case 2.2.0.

Lance Gaige Duncan Jr.'s DOB: (Please use the HIMSS IIP Test Plan v11.0 Job Aid) Today (day of test) the patient is 0 years, 1 months, and 17 days old) hospital paper medical record reflects a dose of hepatitis B was received.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

Lance Gaige Duncan Jr.'s SUT record reflects a dose of hepatitis B was received on Date/Time of Birth. This dose is noted/labeled as 'historical'.

The vaccine forecast for Lance Gaige Duncan Jr.'s has been updated (the patient's vaccination history now reflects a prior dose of hepatitis B vaccine) and recommends a subsequent dose of hepatitis B vaccine at an appropriate interval from the prior dose.)

Go to step 5.4.2 to receive and process ACK from this step.


Test Objectives

To test the ability that the SUT is able to send newly administration vaccine doses to the IIS.

The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.


Both NDC and CVX are required for new immunizations and CVX is required for historical.



Evaluation Criteria

The IIS received a single VXU message with an RXA segment from the SUT containing historical vaccine doses recorded in the SUT.

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22).  The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

Patient Information
ElementData
Patient NameLance Gaige Duncan, Jr.
Mother s Maiden NameKing
ID Number1111
Date/Time of BirthPlease use the HIMSS IIP Test Plan v11.0 Job Aid
Today (day of test) the patient is 0 years, 1 months, and 17 days old

Administrative SexMale
Patient Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone=CP)
E-mail AddressIIPMP@gmail.com
RaceAmerican Indian or Alaska Native
Ethnic GroupNot Hispanic or Latino
Multiple Birth IndicatorNo
Birth Order1


Immunization Registry Information
ElementData
Immunization Registry StatusActive
Immunization Registry Status Effective DatePatient DOB from Job Aid
Publicity CodeReminder/recall - any method
Publicity Code Effective DatePatient DOB from Job Aid
Protection IndicatorNo
Protection Indicator Effective DatePatient DOB from Job Aid


Guardian or Responsible Party - 1
ElementData
NameIngrid Stacy Duncan
RelationshipMother
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1111 (Cellular Phone=CP)
E-mail AddressIIPMP@gmail.com


Guardian or Responsible Party - 2
ElementData
NameSimon Isaiah Duncan, Sr
RelationshipFather
Address749 Evergreen Ter. Unit A Springfield, OR 97477 USA
Phone Number(541) 555-1233 (Cellular Phone=CP)


Vaccine Administration Information - 1 (Historical Entry)
ElementData
Administered Vaccinehepatitis B vaccine, unspecified formulation
Date/Time Start of AdministrationPlease use the HIMSS IIP Test Plan v11.0 Job Aid
Administered Amount
Administered Units
Administration NotesHistorical information - from other provider
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
Route
Administration Site
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered By

Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html


Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405111648-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID IIP-Transmit-10 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Profile Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 1111 Presence-Content Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID IIP-MPI-1 Presence-Content Indifferent
PID-3.4.2 Universal ID
PID-3.4.3 Universal ID Type
PID-3.5 Identifier Type Code MR Value-Test Case Fixed
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Duncan Value-Test Case Fixed
PID-5.2 Given Name Lance Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Gaige Presence-Content Indifferent
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname King Presence-Content Indifferent
PID-6.2 Given Name
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20240215 Presence-Content Indifferent
PID-8 Administrative Sex M Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 1002-5 Value-Test Case Fixed
PID-10.2 Text American Indian or Alaska Native Presence-Test Case Proper
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.4 Alternate Identifier
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
PID-11.2 Other Designation Unit A Value-Test Case Fixed
PID-11.3 City Springfield Value-Test Case Fixed
PID-11.4 State or Province OR Value-Test Case Fixed
PID-11.5 Zip or Postal Code 97477 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type P Value-Test Case Fixed
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13[1].4 Email Address
PID-13[1].6 Area/City Code 541 Value-Test Case Fixed
PID-13[1].7 Local Number 5551111 Value-Test Case Fixed
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type X.400 Value-Profile Fixed
PID-13[2].4 Email Address IIPMP@gmail.com Presence-Content Indifferent
PID-13[2].6 Area/City Code
PID-13[2].7 Local Number
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Value-Test Case Fixed
PID-22.2 Text Not Hispanic or Latino Presence-Test Case Proper
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.4 Alternate Identifier
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator N Value-Test Case Fixed

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - any method Presence-Test Case Proper
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-11.4 Alternate Identifier
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20240405 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20240126 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20240405 Presence-Content Indifferent

NK1[*]
NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Ingrid Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Stacy Presence-Content Indifferent
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Indifferent
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5[1] Phone Number
NK1-5[1].2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5[1].3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5[1].4 Email Address
NK1-5[1].6 Area/City Code 541 Value-Test Case Fixed
NK1-5[1].7 Local Number 5551111 Value-Test Case Fixed
NK1-5[2] Phone Number
NK1-5[2].2 Telecommunication Use Code NET Value-Test Case Fixed
NK1-5[2].3 Telecommunication Equipment Type X.400 Presence-Test Case Proper
NK1-5[2].4 Email Address IIPMP@gmail.com Presence-Content Indifferent
NK1-5[2].6 Area/City Code
NK1-5[2].7 Local Number

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 2 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Duncan Value-Test Case Fixed
NK1-2.2 Given Name Simon Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Isaiah Presence-Content Indifferent
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier FTH Value-Test Case Fixed
NK1-3.2 Text Father Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 749 Evergreen Ter. Value-Test Case Fixed
NK1-4.2 Other Designation Unit A Indifferent
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 541 Value-Test Case Fixed
NK1-5.7 Local Number 5551233 Value-Test Case Fixed

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1115 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2226 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname
ORC-12.3 Given Name
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 45 Value-Test Case Fixed
RXA-5.2 Text Hep B, unspecified formulation Presence-Test Case Proper
RXA-5.3 Name of Coding System CVX Value-Profile Fixed
RXA-5.4 Alternate Identifier Indifferent
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 02 Value-Test Case Fixed
RXA-9.2 Text Historical information - from other provider Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

Test Data Specification

Patient Information
Element Data
Patient Name Lance Gaige Duncan
Mother's Maiden Name King
ID Number 1111
Date/Time of Birth 02/15/2024
Administrative Sex Male
Patient Address 749 Evergreen Ter. Springfield OR 97477 USA
Local Number (541)555-1111
Email IIPMP@gmail.com
Race American Indian or Alaska Native
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator No
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 01/26/2024
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 04/05/2024
Protection Indicator No
Protection Indicator Effective Date 04/05/2024
Guardian or Responsible Party[*]
Guardian or Responsible Party
Element Data
Name Ingrid Stacy Duncan
Relationship Mother
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1111
Phone Number

Guardian or Responsible Party
Element Data
Name Simon Isaiah Duncan
Relationship Father
Address 749 Evergreen Ter. Springfield OR 97477 USA
Phone Number (541)555-1233

Vaccine Administration Information
Element Data
Administered Vaccine Hep B, unspecified formulation
Date/Time Start of Administration 04/05/2024
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route
Administration Site
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By

5.3.2. 5.4.2 - Not evaluated: Receive acknowledgment messages from an IIS during the course of processing the patient immunization record

Test Step Type: TA_RESPONDER

Test Story

Description

SUT is able to Receive and process acknowledgment messages from an IIS that indicate there were no errors found during the course of processing the patient immunization record.



Pre-condition

The SUT has transmitted administered vaccine.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

An acknowledgement (ACK Z23) is received and processed by the SUT.

Go to step 3.3.1


Test Objectives

The SUT is able to receive an acknowledgment in response to VXU transmissions.


Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.

The acknowledgment message is displayed and consumed by the SUT responsible for the content of the administration message.


Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405114221-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID IIP-ACK-1
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID IIP-Transmit-10

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.4. DCM 5.5.0 - Transmit Hep A and Hep A Delete

Test Story

Description

The SUT supports the ability to transmit newly documented refused immunizations to the IIS.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Evaluation Criteria

See test step for details.



5.4.1. 5.5.1 - Transmit VXU for newly documented as administered, Hep A vaccination that was actually refused

Test Step Type: SUT_INITIATOR

Test Story

Description

In Step 3.14.2, Dr. Ramon Bradshaw recommends that Deborah McKay receive a hepatitis A vaccine. Deborah's mother, Angeline McKay declines the recommendation and refuses the vaccine for  Deborah. The Administering practitioner incorrectly documents the administration of the Hep A vaccine in the SUT instead of a refusal in Step 3.14.3.

The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step.


Pre-condition

Deborah McKay exists in the SUT and the practitioner pre-documents the vaccine administration.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

Hep A Vaccine Administration is visible in the SUT and the IIS.

Go to step 5.5.2 to receive and process ACK from this step.


Test Objectives

To test the ability that the SUT is able to send newly administration vaccine doses to the IIS that will later be deleted.


The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Both NDC and CVX are required for new immunizations and CVX is required for historical.


Support for multiple birth indicator and birth order.


Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22).  The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.

Patient Information
ElementData
Patient NameDeborah Charlotte McKay 
Mother s Maiden NameSchroeder
ID Number4444
Date/Time of Birth02/05/2023
Administrative SexFemale
Patient Address600 Cherry Rd. Springfield OR, 97477 USA
Phone Number(541) 555-1236 (Telephone=PH)
RaceBlack or African American
Ethnic GroupNot Hispanic or Latino
Multiple Birth IndicatorYes
Birth Order2


Immunization Registry Information
ElementData
Immunization Registry StatusActive
Immunization Registry Status Effective Date1/26/2024
Publicity CodeReminder/recall - any method
Publicity Code Effective DateToday's date
Protection IndicatorNo
Protection Indicator Effective DateToday's date


Guardian or Responsible Party - 1
ElementData
NameAngeline Ingrid McKay
RelationshipMother
Address600 Cherry Rd. Springfield OR, 97477 USA
Phone Number(541) 555-1236 (Telephone=PH)




Vaccine Administration Information - 1 
ElementData
Administered VaccineHAVRIX 58160-0825-43
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN11
Substance Expiration Date09/27/2029
Substance Manufacturer NameSKB
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw

Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html


Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405115806-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID IIP-Transmit-8 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Profile Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 4444 Presence-Content Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID IIP-MPI-1 Presence-Content Indifferent
PID-3.4.2 Universal ID
PID-3.4.3 Universal ID Type
PID-3.5 Identifier Type Code MR Value-Test Case Fixed
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname McKay Value-Test Case Fixed
PID-5.2 Given Name Deborah Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Charlotte Presence-Content Indifferent
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Schroeder Presence-Content Indifferent
PID-6.2 Given Name
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20230205 Presence-Content Indifferent
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2054-5 Value-Test Case Fixed
PID-10.2 Text Black or African American Presence-Test Case Proper
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.4 Alternate Identifier
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 600 Cherry Rd. Value-Test Case Fixed
PID-11.2 Other Designation
PID-11.3 City Springfield Value-Test Case Fixed
PID-11.4 State or Province OR Value-Test Case Fixed
PID-11.5 Zip or Postal Code 97477 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type P Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 541 Value-Test Case Fixed
PID-13.7 Local Number 5551236 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Value-Test Case Fixed
PID-22.2 Text Not Hispanic or Latino Presence-Test Case Proper
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.4 Alternate Identifier
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 2 Value-Test Case Fixed
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator N Value-Test Case Fixed

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - any method Presence-Test Case Proper
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-11.4 Alternate Identifier
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20240405 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20240126 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20240405 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname McKay Value-Test Case Fixed
NK1-2.2 Given Name Angeline Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Ingrid Presence-Content Indifferent
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 600 Cherry Rd. Value-Test Case Fixed
NK1-4.2 Other Designation
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 541 Value-Test Case Fixed
NK1-5.7 Local Number 5551236 Value-Test Case Fixed

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1116 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2227 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0825-43 Value-Test Case Fixed
RXA-5.2 Text HAVRIX Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 83 Value-Test Case Fixed
RXA-5.5 Alternate Text Hep A, ped/adol, 2 dose Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN11 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LVL Value-Test Case Fixed
RXR-2.2 Text Left Vastus Lateralis Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier PHC70 Value-Test Case Fixed
OBX-5.2 Text Private funds Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V01 Value-Test Case Fixed
OBX-5.2 Text Not VFC eligible Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40
OBX-17.2 Text Eligibility captured at the immunization level
OBX-17.3 Name of Coding System CDCPHINVS
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211211015 Value-Test Case Fixed
OBX-5.2 Text Hepatitis A Vaccine VIS - 10/15/2021 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Deborah Charlotte McKay
Mother's Maiden Name Schroeder
ID Number 4444
Date/Time of Birth 02/05/2023
Administrative Sex Female
Patient Address 600 Cherry Rd. Springfield OR 97477 USA
Local Number (541)555-1236
Race Black or African American
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator Yes
Birth Order 2
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 01/26/2024
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 04/05/2024
Protection Indicator No
Protection Indicator Effective Date 04/05/2024
Guardian or Responsible Party
Element Data
Name Angeline Ingrid McKay
Relationship Mother
Address 600 Cherry Rd. Springfield OR 97477 USA
Phone Number (541)555-1236

Vaccine Administration Information
Element Data
Administered Vaccine HAVRIX
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN11
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Private funds
Vaccine funding program eligibility category Not VFC eligible
Document type Hepatitis A Vaccine VIS - 10/15/2021
Date Vaccine Information Statement Presented 04/05/2024

5.4.2. 5.5.2 Not evaluated: Receive acknowledgment messages from an IIS during the course of processing the patient immunization record

Test Step Type: TA_RESPONDER

Test Story

Description

SUT is able to Receive acknowledgment messages from an IIS during the course of processing the patient immunization record.



Pre-condition

The SUT has transmitted administered vaccine.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

An acknowledgement (ACK Z23) is received and processed by the SUT.

Go to step 5.5.3


Test Objectives

The SUT is able to receive an acknowledgment in response to VXU transmissions.



Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.


The acknowledgment message is displayed and consumed by the SUT responsible for the content of the administration message.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405114221-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID IIP-ACK-1
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID IIP-Transmit-8

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.4.3. 5.5.3 - Transmit delete VXU for newly documented as administered, Hep A vaccination that was actually refused

Test Step Type: SUT_INITIATOR

Test Story

Description

In Step 3.14.2, Dr. Ramon Bradshaw recommends that Deborah McKay receive a hepatitis A vaccine. Deborah's mother, Angeline McKay declines the recommendation and refuses the vaccine for  Deborah. The Administering practitioner incorrectly documents the administration of the Hep A vaccine in the SUT instead of a refusal.

The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to supplied test data in the 'Test Data Specification' section of this test step.


Pre-condition

Debroah McKay exists in the SUT and the practitioner pre-documents the vaccine administration.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

Hep A Vaccine Administration is no longer visible in the SUT or the IIS.

Go to step 5.5.4 to receive and process ACK from this step.


Test Objectives

To test the ability that the SUT allows users to submit vaccine administration deletes.


The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Both NDC and CVX are required for new immunizations and CVX is required for historical.


Evaluation Criteria

The IIS received a single VXU message with an RXA segment containing an action code of "D" from the SUT for newly administered vaccine dose recorded in the SUT.

The UI may not show the codes reference but the SUT SHALL show there is underlying code to support transmission to the IIS as coded data with the RXA Completion status of Delete (D)


The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22).  The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.

Patient Information
ElementData
Patient NameDeborah Charlotte McKay 
Mother s Maiden NameSchroeder
ID Number4444
Date/Time of Birth02/05/2023
Administrative SexFemale
Patient Address600 Cherry Rd. Springfield OR, 97477 USA
Local Number(541) 555-1236 (Telephone=PH)
RaceBlack or African American
Ethnic GroupNot Hispanic or Latino
Multiple Birth IndicatorYes
Birth Order2


Immunization Registry Information
ElementData
Immunization Registry StatusActive
Immunization Registry Status Effective Date1/26/2024
Publicity CodeReminder/recall - any method
Publicity Code Effective DateToday's date
Protection IndicatorNo
Protection Indicator Effective DateToday's date


Guardian or Responsible Party - 1
ElementData
NameAngeline Ingrid McKay
RelationshipMother
Address600 Cherry Rd. Springfield OR, 97477 USA
Phone Number(541) 555-1236 (Telephone=PH)




Vaccine Administration Information - 1 
ElementData
Administered VaccineHAVRIX 58160-0825-43
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration Notes00 New Immunization Record (NIP001)
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN11
Substance Expiration Date09/27/2029
Substance Manufacturer NameSKB
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeDelete
RouteINTRAMUSCULAR
Administration SiteLeft Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw



Notes

IIP has determined that, from a regulatory/program perspective, a SUT should not be required to be able to generate delete messages with the Vaccine Funding Source OBX segment for IIP testing. For IIP purposes, testers may ignore the error notification generated by the NIST IIP Immunization Test Suite when this segment is missing.

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html


Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405132256-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID IIP-Transmit-8 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Profile Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 4444 Presence-Content Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID IIP-MPI-1 Presence-Content Indifferent
PID-3.4.2 Universal ID
PID-3.4.3 Universal ID Type
PID-3.5 Identifier Type Code MR Value-Test Case Fixed
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname McKay Value-Test Case Fixed
PID-5.2 Given Name Deborah Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Charlotte Presence-Content Indifferent
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Schroeder Presence-Content Indifferent
PID-6.2 Given Name
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20230205 Presence-Content Indifferent
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2054-5 Value-Test Case Fixed
PID-10.2 Text Black or African American Presence-Test Case Proper
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.4 Alternate Identifier
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 600 Cherry Rd. Value-Test Case Fixed
PID-11.2 Other Designation
PID-11.3 City Springfield Value-Test Case Fixed
PID-11.4 State or Province OR Value-Test Case Fixed
PID-11.5 Zip or Postal Code 97477 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type P Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 541 Value-Test Case Fixed
PID-13.7 Local Number 5551236 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Value-Test Case Fixed
PID-22.2 Text Not Hispanic or Latino Presence-Test Case Proper
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.4 Alternate Identifier
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 2 Value-Test Case Fixed
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator N Value-Test Case Fixed

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - any method Presence-Test Case Proper
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-11.4 Alternate Identifier
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20240405 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20240126 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20240405 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname McKay Value-Test Case Fixed
NK1-2.2 Given Name Angeline Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Ingrid Presence-Content Indifferent
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 600 Cherry Rd. Value-Test Case Fixed
NK1-4.2 Other Designation
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 541 Value-Test Case Fixed
NK1-5.7 Local Number 5551236 Value-Test Case Fixed

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1116 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2227 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0825-43 Value-Test Case Fixed
RXA-5.2 Text HAVRIX Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 83 Value-Test Case Fixed
RXA-5.5 Alternate Text Hep A, ped/adol, 2 dose Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text mL
RXA-7.3 Name of Coding System UCUM
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text New immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN11 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA D Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Indifferent
RXR-1.2 Text INTRAMUSCULAR Indifferent
RXR-1.3 Name of Coding System NCIT Indifferent
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LVL Indifferent
RXR-2.2 Text Left Vastus Lateralis Indifferent
RXR-2.3 Name of Coding System HL70163 Indifferent
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Indifferent
OBX-2 Value Type CE Indifferent
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Indifferent
OBX-3.2 Text Vaccine funding source Indifferent
OBX-3.3 Name of Coding System LN Indifferent
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier PHC70 Indifferent
OBX-5.2 Text Private funds Indifferent
OBX-5.3 Name of Coding System CDCPHINVS Indifferent
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Indifferent
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Indifferent
OBX-2 Value Type CE Indifferent
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Indifferent
OBX-3.2 Text Vaccine funding program eligibility category Indifferent
OBX-3.3 Name of Coding System LN Indifferent
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier V01 Indifferent
OBX-5.2 Text Not VFC eligible Indifferent
OBX-5.3 Name of Coding System HL70064 Indifferent
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Indifferent
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Indifferent
OBX-17.2 Text Eligibility captured at the immunization level Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Indifferent
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Indifferent
OBX-2 Value Type CE Indifferent
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Indifferent
OBX-3.2 Text Document type Indifferent
OBX-3.3 Name of Coding System LN Indifferent
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211211015 Indifferent
OBX-5.2 Text Hepatitis A Vaccine VIS - 10/15/2021 Indifferent
OBX-5.3 Name of Coding System cdcgs1vis Indifferent
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Indifferent
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Indifferent
OBX-2 Value Type DT Indifferent
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Indifferent
OBX-3.2 Text Date Vaccine Information Statement Presented Indifferent
OBX-3.3 Name of Coding System LN Indifferent
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Indifferent
OBX-5 Observation Value 20240405 Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Indifferent
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Deborah Charlotte McKay
Mother's Maiden Name Schroeder
ID Number 4444
Date/Time of Birth 02/05/2023
Administrative Sex Female
Patient Address 600 Cherry Rd. Springfield OR 97477 USA
Local Number (541)555-1236
Race Black or African American
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator Yes
Birth Order 2
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 01/26/2024
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 04/05/2024
Protection Indicator No
Protection Indicator Effective Date 04/05/2024
Guardian or Responsible Party
Element Data
Name Angeline Ingrid McKay
Relationship Mother
Address 600 Cherry Rd. Springfield OR 97477 USA
Phone Number (541)555-1236

Vaccine Administration Information
Element Data
Administered Vaccine HAVRIX
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN11
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Delete
Route INTRAMUSCULAR
Administration Site Left Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Private funds
Vaccine funding program eligibility category Not VFC eligible
Document type Hepatitis A Vaccine VIS - 10/15/2021
Date Vaccine Information Statement Presented 04/05/2024

5.4.4. 5.5.4 Not evaluated: Receive acknowledgment messages from an IIS during the course of processing the patient immunization record

Test Step Type: TA_RESPONDER

Test Story

Description

SUT is able to Receive acknowledgment messages from an IIS during the course of processing the patient immunization record.



Pre-condition

The SUT has transmitted administered vaccine.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

An acknowledgement (ACK Z23) is received and processed by the SUT.

Go to step 3.14.4


Test Objectives

The SUT is able to receive an acknowledgment in response to VXU transmissions.


Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.


The acknowledgment message is displayed and consumed by the SUT responsible for the content of the administration message.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405114221-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID IIP-ACK-1
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID IIP-Transmit-8

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.5. DCM 5.6.0 - Transmit Hep A Refusal

Test Story

Description

The SUT supports the ability to transmit newly documented refused immunizations to the IIS.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Evaluation Criteria

See test step for details.



5.5.1. 5.6.1 Transmit refusal for Hep A vaccination documented within the SUT to the IIS. Supports step 3.14.4 (Record Refusal)

Test Step Type: SUT_INITIATOR

Test Story

Description

In Step 3.14.2, Dr. Ramon Bradshaw recommends that Deborah McKay receive a hepatitis A vaccine. Deborah's mother, Angeline McKay declines the recommendation and refuses the vaccine for Deborah. The Administering practitioner incorrectly documents the administration of the Hep A vaccine in the SUT instead of a refusal.

The SUT generates an unsolicited vaccine update (VXU - Z22 profile message) correctly and without omission according to the supplied test data in the 'Test Data Specification' section of this test step.


Pre-condition

Debroah McKay exists in the SUT and the practitioner deleted the vaccine that was entered as given. The SUT no longer shows a record of administration for Hep A.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

The HepA refusal and HepB have been sent to the IIS.


Hep A Vaccine Administration is no longer visible in the SUT or the IIS.

Go to step 5.6.2 to receive and process ACK from this step.


Test Objectives

To test the ability that the SUT allows users to submit vaccine administration refusals.


The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.


Both NDC and CVX are required for new immunizations and CVX is required for historical.



Evaluation Criteria

The IIS received a single VXU message with an RXA segment containing an action code of "RE" from the SUT for newly administered vaccine dose recorded in the SUT. User shall record the refusal for hepatitis A in the SUT with the following data: Substance/Treatment Refusal Reason: Parent Decision (NIP002 00);

The UI may not show the codes reference but the SUT SHALL show there is underlying code to support transmission to the IIS as coded data with the RXA Completion status of Refused (RE)

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22).  The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.

The Administered Hep B vaccine is not evaluated, but must conform to the CDCC IZ IG v2.5.1.

Patient Information
ElementData
Patient NameDeborah Charlotte McKay 
Mother s Maiden NameSchroeder
ID Number4444
Date/Time of Birth02/05/2023
Administrative SexFemale
Patient Address600 Cherry Rd. Springfield OR, 97477 USA
Phone Number(541) 555-1236 (Telephone=PH)
RaceBlack or African American
Ethnic GroupNot Hispanic or Latino
Multiple Birth IndicatorYes
Birth Order2


Immunization Registry Information
ElementData
Immunization Registry StatusActive
Immunization Registry Status Effective Date1/26/2024
Publicity CodeReminder/recall - any method
Publicity Code Effective DateToday's date
Protection IndicatorNo
Protection Indicator Effective DateToday's date


Guardian or Responsible Party - 1
ElementData
NameAngeline Ingrid McKay
RelationshipMother
Address600 Cherry Rd. Springfield OR, 97477 USA
Phone Number(541) 555-1236 (Telephone=PH)




Vaccine Administration Information - 1 
ElementData
Administered VaccineHep A, ped/adol, 2 dose, CVX 83 
Date/Time Start of AdministrationToday's date
Administered Amount999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal ReasonParent Decision
Completion StatusRefused
Action CodeAdd/Insert
Route
Administration Site
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Vaccine Administration Information - 2
ElementData
Administered VaccineENGERIX-B 58160-0820-43
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN04
Substance Expiration Date20290927
Substance Manufacturer NameGlaxoSmithKline
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteRight Vastus Lateralis
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw

Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html


Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405132514-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID IIP-Transmit-9 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Profile Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 4444 Presence-Content Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID IIP-MPI-1 Presence-Content Indifferent
PID-3.4.2 Universal ID
PID-3.4.3 Universal ID Type
PID-3.5 Identifier Type Code MR Value-Test Case Fixed
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname McKay Value-Test Case Fixed
PID-5.2 Given Name Deborah Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Charlotte Presence-Content Indifferent
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Schroeder Presence-Content Indifferent
PID-6.2 Given Name
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20230205 Presence-Content Indifferent
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2054-5 Value-Test Case Fixed
PID-10.2 Text Black or African American Presence-Test Case Proper
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.4 Alternate Identifier
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 600 Cherry Rd. Value-Test Case Fixed
PID-11.2 Other Designation
PID-11.3 City Springfield Value-Test Case Fixed
PID-11.4 State or Province OR Value-Test Case Fixed
PID-11.5 Zip or Postal Code 97477 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type P Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 541 Value-Test Case Fixed
PID-13.7 Local Number 5551236 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Value-Test Case Fixed
PID-22.2 Text Not Hispanic or Latino Presence-Test Case Proper
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.4 Alternate Identifier
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 2 Value-Test Case Fixed
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator N Value-Test Case Fixed

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - any method Presence-Test Case Proper
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-11.4 Alternate Identifier
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20240405 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20240126 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20240405 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname McKay Value-Test Case Fixed
NK1-2.2 Given Name Angeline Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Ingrid Presence-Content Indifferent
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 600 Cherry Rd. Value-Test Case Fixed
NK1-4.2 Other Designation
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 541 Value-Test Case Fixed
NK1-5.7 Local Number 5551236 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1117 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1120 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3100 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier OFM Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 83 Value-Test Case Fixed
RXA-5.2 Text Hep A, ped/adol, 2 dose Presence-Test Case Proper
RXA-5.3 Name of Coding System CVX Value-Profile Fixed
RXA-5.4 Alternate Identifier
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier 00 Value-Test Case Fixed
RXA-18.2 Text Parental refusal Value-Test Case Fixed
RXA-18.3 Name of Coding System NIP002 Value-Profile Fixed
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status RE Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0820-43 Value-Test Case Fixed
RXA-5.2 Text ENGERIX-B Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 08 Value-Test Case Fixed
RXA-5.5 Alternate Text Hep B, adolescent or pediatric Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN04 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier RVL Value-Test Case Fixed
RXR-2.2 Text Right Vastus Lateralis Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier PHC70 Value-Test Case Fixed
OBX-5.2 Text Private funds Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V01 Value-Test Case Fixed
OBX-5.2 Text Not VFC eligible Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300005911230512 Value-Test Case Fixed
OBX-5.2 Text Hepatitis B Vaccine VIS - 05/12/2023 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Deborah Charlotte McKay
Mother's Maiden Name Schroeder
ID Number 4444
Date/Time of Birth 02/05/2023
Administrative Sex Female
Patient Address 600 Cherry Rd. Springfield OR 97477 USA
Local Number (541)555-1236
Race Black or African American
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator Yes
Birth Order 2
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 01/26/2024
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 04/05/2024
Protection Indicator No
Protection Indicator Effective Date 04/05/2024
Guardian or Responsible Party
Element Data
Name Angeline Ingrid McKay
Relationship Mother
Address 600 Cherry Rd. Springfield OR 97477 USA
Phone Number (541)555-1236

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine Hep A, ped/adol, 2 dose
Date/Time Start of Administration 04/05/2024
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental refusal
Completion Status Refused
Action Code Add
Route
Administration Site
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Vaccine Administration Information
Element Data
Administered Vaccine ENGERIX-B
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN04
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Right Vastus Lateralis
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Private funds
Vaccine funding program eligibility category Not VFC eligible
Document type Hepatitis B Vaccine VIS - 05/12/2023
Date Vaccine Information Statement Presented 04/05/2024

5.5.2. 5.6.2 Not evaluated: Receive acknowledgment messages from an IIS during the course of processing the patient immunization record

Test Step Type: TA_RESPONDER

Test Story

Description

SUT is able to Receive acknowledgment messages from an IIS during the course of processing the patient immunization record.



Pre-condition

The SUT has transmitted administered vaccine.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

An acknowledgement (ACK Z23) is received and processed by the SUT.

Go to step 7.1.1


Test Objectives

The SUT is able to receive an acknowledgment in response to VXU transmissions.


Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.

The acknowledgment message is displayed and consumed by the SUT responsible for the content of the administration message.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405114221-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID IIP-ACK-1
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID IIP-Transmit-9

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

5.6. AJM 5.7.0 - Transmit patient protection status

Test Story

Description

Transmit patient's protection indicator for a patient without consent (no sharing of patient data) to IIS



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Evaluation Criteria

See test step for details.



5.6.1. 5.7.1 Transmit patient's protection indicator for a patient without consent (no sharing of patient data) to IIS

Test Step Type: SUT_INITIATOR

Test Story

Description

In Step 3.11.1, administering provider, Daniela Jennifer Wyatt, records a dose of GARDASIL 9 (Lot Number IIPVAXN08) in the SUT for Alexandria Jacqueline Montoya (DOB 02/18/2012), triggering the transmission of the record to the IIS.



Pre-condition

Alexandria Jacqueline Montoya (DOB 02/18/2012) is registered in the SUT.

In Step 3.11.1, administering provider, Daniela Jennifer Wyatt, records a dose of GARDASIL 9 (Lot Number IIPVAXN08) in the SUT for Alexandria Jacqueline Montoya (DOB 02/18/2012).

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

The SUT is sent an unsolicited vaccine update (VXU) message which indicated the patient's protection indicator (PD1-12) was "Y" (protected, do not share) along with an effective date (PD1-13).

Go to step 5.7.2 to receive and process ACK from this transmission.


Test Objectives

To test the ability that the SUT is able to transmit an unsolicited vaccine update (VXU) message which indicates the patient's protection indicator (PD1-12) is "Y" (protected, do not share) along with an effective date (PD1-13).

The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization. Both NDC and CVX are required for new immunizations and CVX is required for historical.

Support for no consent given.

Support for long first and middle name.






Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22).  The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.

ElementData
Patient NameAlexandria Jacqueline Montoya 
Mother s Maiden NameHayes
ID Number2222
Date/Time of Birth03/27/2012
Administrative SexFemale
Patient Address82 Evergreen Ter Springfield OR, 97477 USA
Phone Number(541) 555-1235 (Cellular Phone= CP)
RaceWhite
Ethnic GroupNot Hispanic or Latino
Multiple Birth IndicatorNo
Birth Order1


Immunization Registry Information
ElementData
Immunization Registry StatusActive
Immunization Registry Status Effective Date1/26/2024
Publicity CodeReminder/recall - any method
Publicity Code Effective DateToday's date
Protection IndicatorYes
Protection Indicator Effective DateToday's date


Guardian or Responsible Party - 1
ElementData
NameMaria Christina Montoya
RelationshipMother
Address82 Evergreen Ter Springfield OR, 97477 USA USA
Phone Number(541) 555-1235 (Cellular Phone= CP)




Vaccine Administration Information - 1 
ElementData
Administered VaccineGARDASIL 9 00006-4121-01
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew immunization record
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN08
Substance Expiration Date09/27/2029
Substance Manufacturer NameMerck and Co., Inc.
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Deltoid
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw
CVX165
Observations
ElementData
Vaccine Funding SourcePrivate funds
Vaccine Program EligibilityVFC eligible - Medicaid/Medicaid Managed Care
Document TypeHPV (Human Papillomavirus) Vaccine VIS - 08/06/2021
Date VIS PresentedToday's date



Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html


Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405132728-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Test Case Fixed
MSH-10 Message Control ID IIP-Transmit-7 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Profile Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 2222 Presence-Content Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID IIP-MPI-1 Presence-Content Indifferent
PID-3.4.2 Universal ID
PID-3.4.3 Universal ID Type
PID-3.5 Identifier Type Code MR Value-Test Case Fixed
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Montoya Value-Test Case Fixed
PID-5.2 Given Name Alexandria Presence Length-Configuration
PID-5.3 Second and Further Given Names or Initials Thereof Jacqueline Presence Length-Configuration
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Hayes Presence-Content Indifferent
PID-6.2 Given Name
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20120327 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Presence-Test Case Proper
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.4 Alternate Identifier
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 82 Evergreen Ter Value-Test Case Fixed
PID-11.2 Other Designation
PID-11.3 City Springfield Value-Test Case Fixed
PID-11.4 State or Province OR Value-Test Case Fixed
PID-11.5 Zip or Postal Code 97477 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type P Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 541 Value-Test Case Fixed
PID-13.7 Local Number 5551235 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Value-Test Case Fixed
PID-22.2 Text Not Hispanic or Latino Presence-Test Case Proper
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.4 Alternate Identifier
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator N Value-Test Case Fixed

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - any method Presence-Test Case Proper
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-11.4 Alternate Identifier
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20240405 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20240126 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20240405 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Montoya Value-Test Case Fixed
NK1-2.2 Given Name Maria Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Christina Presence-Content Indifferent
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Presence-Test Case Proper
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.4 Alternate Identifier
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 82 Evergreen Ter Value-Test Case Fixed
NK1-4.2 Other Designation
NK1-4.3 City Springfield Value-Test Case Fixed
NK1-4.4 State or Province OR Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 97477 Value-Test Case Fixed
NK1-4.6 Country USA Value-Test Case Fixed
NK1-4.7 Address Type P Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 541 Value-Test Case Fixed
NK1-5.7 Local Number 5551235 Value-Test Case Fixed

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1118 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 2229 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00006-4121-01 Value-Test Case Fixed
RXA-5.2 Text GARDASIL 9 Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 165 Value-Test Case Fixed
RXA-5.5 Alternate Text HPV9 Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number IIPVAXN08 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Value-Test Case Fixed
RXA-17.2 Text Merck and Co., Inc. Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier PHC70 Value-Test Case Fixed
OBX-5.2 Text Private funds Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V02 Value-Test Case Fixed
OBX-5.2 Text VFC eligible - Medicaid/Medicaid Managed Care Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300029511210806 Value-Test Case Fixed
OBX-5.2 Text HPV (Human Papillomavirus) Vaccine VIS - 08/06/2021 Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Alexandria Jacqueline Montoya
Mother's Maiden Name Hayes
ID Number 2222
Date/Time of Birth 03/27/2012
Administrative Sex Female
Patient Address 82 Evergreen Ter Springfield OR 97477 USA
Local Number (541)555-1235
Race White
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator No
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 01/26/2024
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 04/05/2024
Protection Indicator Yes
Protection Indicator Effective Date 04/05/2024
Guardian or Responsible Party
Element Data
Name Maria Christina Montoya
Relationship Mother
Address 82 Evergreen Ter Springfield OR 97477 USA
Phone Number (541)555-1235

Vaccine Administration Information
Element Data
Administered Vaccine GARDASIL 9
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN08
Substance Expiration Date 09/27/2029
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Deltoid
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Private funds
Vaccine funding program eligibility category VFC eligible - Medicaid/Medicaid Managed Care
Document type HPV (Human Papillomavirus) Vaccine VIS - 08/06/2021
Date Vaccine Information Statement Presented 04/05/2024

5.6.2. 5.7.2 Not evaluated: Receive acknowledgment messages from an IIS during the course of processing the patient immunization record

Test Step Type: TA_RESPONDER

Test Story

Description

SUT is able to Receive acknowledgment messages from an IIS during the course of processing the patient immunization record.



Pre-condition

The SUT has transmitted a record for a protected patient.

Daniela Jennifer Wyatt is the practitioner.


Post-Condition

An acknowledgement (ACK Z23) is received and processed by the SUT.

Go to step 3.12.1


Test Objectives

The SUT is able to receive an acknowledgment in response to VXU transmissions.



Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.

The acknowledgement message is displayed and consumed by the SUT responsible for the content of the administration message.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405114221-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID IIP-ACK-1
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID IIP-Transmit-7

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

6. 6.0.0 - Capability: Patient access

Test Story

Description

This "test group" includes basic functionality that allows patients or their caregivers access to immunization records.



Evaluation Criteria

See test step for details



6.1. 6.1.0 - Provide patient or a user on the patient's behalf electronic access to patient's immunization record

Test Story

Description

Includes basic functionality that allows patients or their caregivers access to immunization records.



Evaluation Criteria

See test step for details



6.1.1. 6.1.1 - Attests that patients or their caregivers can electronically access a patient's immunization record

Test Step Type: SUT_MANUAL

Test Story

Description

The SUT supports the ability for patients or a user on the patient's behalf access to the patient's immunization record. This ability is managed via attestation as many SUTs provide such access through patient portals which may be separate products managed by different vendors. The ability requires that the SUT makes all immunizations administered available to the patient.



Pre-condition

Patient data exists in the SUT



Post-Condition

Vaccines given appear in patient's medical records and are accessible as immunization history.



Test Objectives

To test the ability that the SUT can allow patients or their caregivers to electronically access the patient's Immunization record.



Evaluation Criteria

This is a non-evaluated test step that must be performed to support other associated steps.


This was an attestation item-previously attested to.


To achieve recognition for this capability, the SUT representative will provide acceptable answers to the following questions:  

(1) Does the SUT provide immunization history and newly administered vaccine data to a site available directly for patient or or a user on the patient's behalf access?  Acceptable answer: Yes.    

(2) Explain how administered vaccines populate the patient access site. 

Acceptable answer: Via direct interface with a portal provided by the SUT (e.g., Epic and My Chart) or with an external portal; 

Also acceptable: via an APi to the portal selected by the patient or a user on the patient's behalf.  



7. 7.0.0 - Capability: Clinical Configuration

Test Story

Description

This "test group" includes basic functionality that allows the SUT to be configured and updated to meet new vaccination reporting requirements.



Pre-condition

Dr. Ramon Michael Bradshaw is the ordering practitioner.

Daniela Jennifer Wyatt is the administering practitioner.


7.1. FIN 7.1.0 - Add New Vaccine Codes

Test Story

Description

Demonstrate the ability to add new vaccine codes for a novel virus vaccine prior to its availability in standard medication knowledge bases. The purpose of adding the new code is to allow entry of the vaccine in inventory and administering it to a patient.



Pre-condition

Dr. Ramon Michael Bradshaw is the ordering practitioner.

Daniela Jennifer Wyatt is the administering practitioner.


Evaluation Criteria

See test step for details.



7.1.1. 7.1.1 - Accommodate updates to vaccine code sets (vaccine codes (CVX), National Drug Codes (NDC), and Vaccine Information Statement codes (VIS)) when released from CDC

Test Step Type: SUT_MANUAL

Test Story

Description

CDC identified a new variant of tick-borne Heartland disease causing rapid and significant development of leucopenia, thrombocytopenia, high propensity for intracerebral hemorrhage, and renal failure. The incidence rose sharply beginning March 2024 due to climate change with proliferation of lone star ticks (Amblyomma americanum) and their rapid spread to northern and western states. Due to the increase in disease incidence and severity, the White House established a Heartland Disease Commission and funded rapid development of Heartland-24 vaccine. The first such vaccine, Heartland-24_mRNA just became available but it has not yet been added to commercial drug knowledge bases. The vaccine is available to physician practices and pharmacies but the coding must be added to existing content available in commerical drug knowledge bases. Heartland-24_mRNA vaccine is a single-dose vaccine, given IM, and recommended for all adults over the age of 50 residing in or frequenting non-urban environments.



Pre-condition

Availability of new vaccine data CVX, NDC (provided in evaluation criteria)



Post-Condition

The new vaccine codes exists in the SUT.

Go to step 7.1.2


Test Objectives

To test the ability that the SUT can support the entry of newly developed vaccine code sets.



Evaluation Criteria

New vaccine codes are available in the SUT with minimum data elements as noted below:

If not all displayed then SUT must explain how the data are made available.

Product Name (This may vary with each implementation)Heartland-24_mRNA
Unit-of-Sale (Box) NDC8077-0743-15
Unit-of-Use (Syringe or Vial) NDC8077-0743-15
Generic Name (CVX 234)HVV
ManufacturerModerna
Lot NumberHVV8071524
Expiration Date09/27/2029
Funding SourcePublic
CVX Code234
MVX CodeMOD
Expiration Date20290731
PackagingUnknown
Trade NameHeartland Virus Vax
Vaccine Information Sheet: Heartland-24 Vaccine 03-28-2024 VIS
Program Code & descriptionIIP024/HeartlandVV-Program
VIS Fully-encoded text string253088698300023411240207

7.1.2. 7.1.2 Not evaluated-Supports 7.1.1 Add New Vaccine Codes. Enter vaccine inventory for newly developed vaccine

Test Step Type: SUT_MANUAL

Test Story

Description

After receiving the inventory for this newly developed vaccine, details are entered into the SUT with the applicable codes and data.



Pre-condition

The vaccine supply is received at the clinic and is available to be added to the SUT inventory.



Post-Condition

The vaccine is available to be ordered in the SUT.

Go to step 7.1.3


Test Objectives

That the SUT is able to add newly developed vaccines with all applicable codes to the inventory to be ordered by practitioners.


Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.

Vaccine inventory entered with the following information:

Product Name (This may vary with each implementation)Heartland-24_mRNA
Unit-of-Sale (Box) NDC8077-0743-15
Unit-of-Use (Syringe or Vial) NDC8077-0743-15
Generic Name (CVX 234)HVV
ManufacturerModerna
Lot NumberHVV8071524
Expiration Date9/27/2029
Funding SourcePublic
Doses on Hand50
CVX Code234
MVX CodeMOD
HL7 Expiration Date20290731
Funding Source CodePublic
PackagingUnknown
Trade NameHeartland Virus Vax
Program Code & descriptionIIP024/HeartlandVV-Program

7.1.3. 7.1.3 Not evaluated-Supports 7.1.1 Add New Vaccine Codes. Order new vaccine for patient administration

Test Step Type: SUT_MANUAL

Test Story

Description

After being approved by FDA and CDC, Finley Ira Nash (DOB 04/05/1966) is looking to be vaccinated against Heartland virus (a rare tick-borne virus). Dr. Ramon Bradshaw orders the vaccine. 

The patient also states he needs a hepatitis B vaccine for new employment. The patient has no vaccine history and the practitioner also orders Hep B vaccine to start the series.




Pre-condition

Dr. Ramon Michael Bradshaw is the ordering practitioner.

The new vaccine code exists in the SUT

The new vaccine and the Hep B vaccine for adults is available to order within the SUT and administer to a patient.

Availability of new vaccine data from Steps 7.1.1 and 7.1.2



Post-Condition

The patient has been selected and the vaccines have been ordered.

Go to step 7.1.4


Test Objectives

That the SUT is able to order newly developed vaccines which have been recently updated/added to the SUT ordering module.


Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.

Vaccine #1 to be ordered:
Product Name (This may vary with each implementation)Heartland-24_mRNA
Generic Name (CVX 234)HVV
CVX Code234


Vaccine #2 to be ordered:
Product Name (This may vary with each implementation)ENGERIX-B 
Generic Name (CVX 43)Hep B, adult
CVX Code43


SUT Users 
Ordering ProviderRamon Michael Bradshaw
Entering OrganizationOregon Family Medicine
Order Entered ByDaniela Jennifer Wyatt


Patient Information

ID Number7777
ID TypeMedical record number
Name
FirstFinley
MiddleIra
LastNash
Suffix
Date of Birth04/05/1966
SexMale
Race¹Asian
Ethnicity¹Hispanic or Latino
Permanent Address¹
Address Line 1¹700 Locust Ln
Address Line 2
City¹Springfield
State¹OR
Zip Code¹97477
Country¹USA
Phone Number¹(541) 000-0007
Use¹Primary Residence Number
Type¹Telephone
Part of a multiple birth?¹No
Birth order¹1
Reminder Recall¹Reminder/recall - any method
Protected?¹No
IIS Status¹Active
Deceased?¹No
Vaccine Program Eligibility¹State Program Eligibility
Vaccine Program Eligibility2Not VFC eligible
¹ - If required by the SUT

7.1.4. 7.1.4 Record vaccine administration for new vaccine product with new vaccine program eligibility code

Test Step Type: SUT_MANUAL

Test Story

Description

After being approved by FDA and CDC Finley Ira Nash (DOB 04/05/1966) is vaccinated with a new vaccine for Heartland virus (a rare tick-borne virus), along with a Hep B vaccine that the patient states is required for new employment. The patient has no record of hep B vaccine and the practitioner starts the series.




Pre-condition

Daniela Jennifer Wyatt is the administering practitioner.


The vaccines have been ordered and the new VFC code IIP024 exists in the SUT.



Post-Condition

Finley Ira Nash  (DOB 04/05/1966) is administered a dose of Heartland Virus vaccine without a scannable 2D barcode, it has been recorded in the SUT and is visible to SUT users.

Finley Ira Nash  (DOB 04/05/1966) is administered a dose of Hep B adult vaccine with a scannable 2D barcode, it has been recorded in the SUT and is visible to SUT users.

Go to step 7.1.5 to transmit vaccines from this step.


Test Objectives

To test the ability that the SUT allows for manual entry of data from newly entered vaccine product in the SUT inventory.



Evaluation Criteria

Finley Ira Nash  (DOB 04/05/1966) has been administered vaccines by practitioner Daniela Jennifer Wyatt and the following information is entered into the patient record and visible in the SUT:

Item 1
Product Name (This may vary with each implementation)Heartland-24_mRNA
Date AdministeredToday's date
Unit-of-Sale (Box) NDC8077-0743-15
ManufacturerModerna
Lot NumberHVV8071524
Expiration Date09/27/2029
Unit-of-Use (Vial/Syringe) Image that shall not be scanned-manually entered8077-0743-15
Patient Dose-level EligibilityIIP024 HeartlandHVV-Program
Funding SourcePublic
RouteINTRAMUSCULAR
SiteLeft Deltoid
VIS GivenHeartland-24 Vaccine 03-28-2024 VIS
CVX Code234
MVX CodeMOD
Generic Name (CVX 234)HVV
Dose/units0.5mL


Item 2
Product Name (This may vary with each implementation)Hep B, adult
Date AdministeredToday's date
Unit-of-Sale (Box) NDC58160-0821-34
ManufacturerGlaxoSmithKline
Lot NumberIIPVAXN03
Expiration Date9/27/2029
Unit-of-Use (Vial/Syringe) barcode58160-0821-05



GTIN 10358160821056
Patient Dose-level EligibilityNot VFC eligible
Funding SourcePrivate funds
RouteINTRAMUSCULAR
SiteRight Deltoid
VIS GivenHepatitis B Vaccine VIS 
CVX Code43
MVX CodeSKB
Generic Name (CVX 43)Hep B, adult
Dose/units0.5mL

7.1.5. 7.1.5 - Transmit new vaccine code administered with new vaccine program eligibility code documented within the SUT to the IIS

Test Step Type: SUT_INITIATOR

Test Story

Description

After being approved by FDA and CDC Finley Ira Nash (DOB 04/05/1966) is vaccinated with a new vaccine for Heartland virus (a rare tick-borne virus), along with a Hep B vaccine that the patient states is required for new employment. The patient has no record of hep B vaccine and the practitioner starts the series.


Vaccine Name: Heartland-24_mRNA

Vaccine Manufacturer (if required by the SUT): Moderna
CVX Code: 234
National Drug Code (NDC): 8077-0743-15
Vaccine Information Sheet: Heartland-24 Vaccine 03-28-2024 VIS
Vaccine MVX: MOD


Vaccine Name: Hep B, Adult (ENGERIX-B)

Vaccine Manufacturer (if required by the SUT):GlaxoSmithKline
CVX Code:43
National Drug Code (NDC): 58160-0820-43
Vaccine Information Sheet: Hepatitis B Vaccine VIS
Vaccine MVX: SKB


Pre-condition

Finley Ira Nash  (DOB 04/05/1966) is administered a dose of Heartland Virus vaccine without a scannable 2D barcode, it has been recorded in the SUT and is visible to SUT users.
Finley Ira Nash  (DOB 04/05/1966) is administered a dose of Hep B adult vaccine with a scannable 2D barcode, it has been recorded in the SUT and is visible to SUT users.

Daniela Jennifer Wyatt is the administering practitioner.


Post-Condition

The vaccines have been transmitted from the SUT to the IIS.

Go to step 7.1.6 to receive and process ACK from this step.


Test Objectives
  • To test the ability that the  SUT can support transmission of newly developed vaccine data recorded in the SUT
  • The SUT links standard codes (i.e., LOINC for tests or evaluation tools, NDC codes for current immunizations, CVX for historical immunizations, MVX manufacturer codes, VIS codes, and appropriate codes for administration site, route, method, etc.) to discrete data elements associated with an immunization.
  • Both NDC and CVX are required for new immunizations and CVX is required for historical.
  • Support for Sending Responsible Organization (MSH-22) and Receiving Responsible Organization (MSH-23) to include: 1. Identifier, 2. Identifier Type Code, 3. Assigning Authority for the Identifier
  • Support for OIDs
  • Support for Adult Not VFC Eligible




Evaluation Criteria

The IIS received a single VXU message with multiple RXA segments from the SUT containing newly developed vaccine data and new vaccine program eligibility code recorded in the SUT as well as the Hep B adult vaccine dose information.


The IIS received a single VXU message with multiple OBX segments from the SUT containing Program eligibility for the newly administered vaccine doses recorded in the SUT.


The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22).  The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

This IIP test plan tests clients with NDC as the primary code set and CVX as an alternate code set. Please note that this configuration may vary among jurisdictions. NDC is required for all new administrations and CVX for historical but can include NDC if known.

See Facility preload Information for OIDs and additional MSH requirements.

ElementData
Patient NameFinley Ira Nash
Mother s Maiden Name
ID Number7777
Date/Time of Birth04/05/1966
Administrative SexMale
Patient Address700 Locust Ln Springfield OR, 97477 USA
Phone Number(541) 555-0007 (Cellular Phone=CP)
RaceAsian
Ethnic GroupHispanic or Latino
Multiple Birth IndicatorNo
Birth Order1


Immunization Registry Information
ElementData
Immunization Registry StatusActive
Immunization Registry Status Effective Date1/26/2024
Publicity CodeReminder/recall - any method
Publicity Code Effective DateToday's date
Protection IndicatorNo
Protection Indicator Effective DateToday's date


Guardian or Responsible Party - 1
ElementData
Name
Relationship
Address
Phone Number




Vaccine Administration Information - 1 
ElementData
Administered VaccineHeartland-24_mRNA
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew Immunization
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberHVV8071524
Substance Expiration Date09/27/2029
Substance Manufacturer NameModerna
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteLeft Deltoid
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw


Observations vax 1
ElementData
Vaccine Funding SourcePublic
Vaccine Program EligibilityHeartlandVV-Program
Document TypeHeartland-24 Vaccine 03-28-2024 VIS
Date VIS PresentedToday's date


Vaccine Administration Information - 2
ElementData
Administered VaccineHep B, adult
Date/Time Start of AdministrationToday's date
Administered Amount0.5
Administered UnitsmL
Administration NotesNew Immunization
Administering ProviderDaniela Jennifer Wyatt
Substance Lot NumberIIPVAXN03
Substance Expiration Date9/27/2029
Substance Manufacturer NameGlaxoSmithKline
Substance/Treatment Refusal Reason
Completion StatusComplete
Action CodeAdd/Insert
RouteINTRAMUSCULAR
Administration SiteRight Deltoid
Entering OrganizationOregon Family Medicine
Entered ByDaniela Jennifer Wyatt
Ordered ByRamon Michael Bradshaw




Observations vax 2
ElementData
Vaccine Funding SourcePrivate funds
Vaccine Program EligibilityNot VFC eligible
Document TypeHepatitis B Vaccine VIS 
Date VIS PresentedToday's date







Notes

The VIS encoded value that is associated with the most current VIS for the vaccines and evaluated in the transmit message, can be found in the CDC VIS Lookup Table located here: https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html


Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID SUT-APP Presence-Configuration
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.40.1 Presence-Test Case Proper
MSH-3.3 Universal ID Type ISO Value-Profile Fixed
MSH-4 Sending Facility
MSH-4.1 Namespace ID OFM Presence-Configuration
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.40.2 Presence-Test Case Proper
MSH-4.3 Universal ID Type ISO Value-Profile Fixed
MSH-5 Receiving Application
MSH-5.1 Namespace ID IIP-IIS-APP Presence-Configuration
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.40.3 Presence-Test Case Proper
MSH-5.3 Universal ID Type ISO Value-Profile Fixed
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIP Presence-Configuration
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.40.4 Presence-Test Case Proper
MSH-6.3 Universal ID Type ISO Value-Profile Fixed
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405115441-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID IIP-Transmit-11 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Profile Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Oregon Family Medicine Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID OFM Presence-Configuration
MSH-22.6.2 Universal ID 2.16.840.1.113883.3.72.5.40.8 Presence-Test Case Proper
MSH-22.6.3 Universal ID Type ISO Value-Profile Fixed
MSH-22.7 Identifier Type Code XX Value-Test Case Fixed
MSH-22.10 Organization Identifier 197028 Presence-Configuration
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Immunization Integration Program Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID IIP Presence-Configuration
MSH-23.6.2 Universal ID 2.16.840.1.113883.3.72.5.40.9 Presence-Test Case Proper
MSH-23.6.3 Universal ID Type ISO Value-Profile Fixed
MSH-23.7 Identifier Type Code XX Value-Test Case Fixed
MSH-23.10 Organization Identifier 197027 Presence-Configuration

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 7777 Presence-Content Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID IIP-MPI-1 Presence-Content Indifferent
PID-3.4.2 Universal ID 2.16.840.1.113883.3.72.5.40.5 Presence-Test Case Proper
PID-3.4.3 Universal ID Type ISO Value-Profile Fixed
PID-3.5 Identifier Type Code MR Value-Test Case Fixed
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Nash Value-Test Case Fixed
PID-5.2 Given Name Finley Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Ira Presence-Content Indifferent
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname
PID-6.2 Given Name
PID-6.7 Name Type Code
PID-7 Date/Time of Birth
PID-7.1 Time 19660405 Value-Test Case Fixed
PID-8 Administrative Sex M Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2028-9 Value-Test Case Fixed
PID-10.2 Text Asian Presence-Test Case Proper
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.4 Alternate Identifier
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 700 Locust Ln Value-Test Case Fixed
PID-11.2 Other Designation
PID-11.3 City Springfield Value-Test Case Fixed
PID-11.4 State or Province OR Value-Test Case Fixed
PID-11.5 Zip or Postal Code 97477 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type P Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type CP Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 541 Value-Test Case Fixed
PID-13.7 Local Number 5550007 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Presence-Test Case Proper
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.4 Alternate Identifier
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator N Value-Test Case Fixed
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator N Value-Test Case Fixed

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Value-Test Case Fixed
PD1-11.2 Text Reminder/recall - any method Presence-Test Case Proper
PD1-11.3 Name of Coding System HL70215 Value-Test Case Fixed
PD1-11.4 Alternate Identifier
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20240405 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Value-Test Case Fixed
PD1-17 Immunization Registry Status Effective Date 20240126 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20240405 Presence-Content Indifferent

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1119 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID 2.16.840.1.113883.3.72.5.40.10 Presence-Test Case Proper
ORC-2.4 Universal ID Type ISO Value-Profile Fixed
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3000 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID 2.16.840.1.113883.3.72.5.40.10 Presence-Test Case Proper
ORC-3.4 Universal ID Type ISO Value-Profile Fixed
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID 2.16.840.1.113883.3.72.5.40.7 Presence-Test Case Proper
ORC-10.9.3 Universal ID Type ISO Value-Profile Fixed
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw Value-Test Case Fixed
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID 2.16.840.1.113883.3.72.5.40.7 Presence-Test Case Proper
ORC-12.9.3 Universal ID Type ISO Value-Profile Fixed
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 1120 Presence-Content Indifferent
ORC-2.2 Namespace ID OFM Presence-Content Indifferent
ORC-2.3 Universal ID 2.16.840.1.113883.3.72.5.40.10 Presence-Test Case Proper
ORC-2.4 Universal ID Type ISO Value-Profile Fixed
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 3001 Presence-Content Indifferent
ORC-3.2 Namespace ID OFM Presence-Content Indifferent
ORC-3.3 Universal ID 2.16.840.1.113883.3.72.5.40.10 Presence-Test Case Proper
ORC-3.4 Universal ID Type ISO Value-Profile Fixed
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Wyatt Value-Test Case Fixed
ORC-10.3 Given Name Daniela Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-10.9.2 Universal ID 2.16.840.1.113883.3.72.5.40.7 Presence-Test Case Proper
ORC-10.9.3 Universal ID Type ISO Value-Profile Fixed
ORC-10.10 Name Type Code L Value-Test Case Fixed
ORC-10.13 Identifier Type Code PRN Value-Test Case Fixed
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Bradshaw
ORC-12.3 Given Name Ramon Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof Michael Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
ORC-12.9.2 Universal ID 2.16.840.1.113883.3.72.5.40.7 Presence-Test Case Proper
ORC-12.9.3 Universal ID Type ISO Value-Profile Fixed
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.13 Identifier Type Code MD Value-Test Case Fixed
ORC-17 Entering Organization
ORC-17.1 Identifier 197028 Presence-Content Indifferent
ORC-17.2 Text Oregon Family Medicine Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Test Case Fixed
ORC-17.4 Alternate Identifier
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed List
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 8077-0743-15 Value-Test Case Fixed
RXA-5.2 Text Heartland-24_mRNA Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 234 Value-Test Case Fixed
RXA-5.5 Alternate Text HVV Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID 2.16.840.1.113883.3.72.5.40.7 Presence-Test Case Proper
RXA-10.9.3 Universal ID Type ISO Value-Profile Fixed
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID 2.16.840.1.113883.3.72.5.40.12 Presence-Test Case Proper
RXA-11.4.3 Universal ID Type ISO Value-Profile Fixed
RXA-15 Substance Lot Number HVV8071524 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MOD Value-Test Case Fixed
RXA-17.2 Text Moderna Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20240405 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0821-05 Value-Test Case Fixed
RXA-5.2 Text ENGERIX-B Presence-Test Case Proper
RXA-5.3 Name of Coding System NDC Value-Profile Fixed
RXA-5.4 Alternate Identifier 43 Value-Test Case Fixed
RXA-5.5 Alternate Text Hep B, adult Presence-Test Case Proper
RXA-5.6 Name of Alternate Coding System CVX Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Test Case Proper
RXA-7.3 Name of Coding System UCUM Value-Profile Fixed
RXA-7.4 Alternate Identifier
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Presence-Test Case Proper
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.4 Alternate Identifier
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Wyatt Value-Test Case Fixed
RXA-10.3 Given Name Daniela Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID OFM-PI-1 Presence-Content Indifferent
RXA-10.9.2 Universal ID 2.16.840.1.113883.3.72.5.40.7 Presence-Test Case Proper
RXA-10.9.3 Universal ID Type ISO Value-Profile Fixed
RXA-10.10 Name Type Code L Value-Test Case Fixed
RXA-10.13 Identifier Type Code PRN Value-Test Case Fixed
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID OFM Presence-Content Indifferent
RXA-11.4.2 Universal ID 2.16.840.1.113883.3.72.5.40.12 Presence-Test Case Proper
RXA-11.4.3 Universal ID Type ISO Value-Profile Fixed
RXA-15 Substance Lot Number IIPVAXN03 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20290927 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Value-Test Case Fixed
RXA-17.2 Text GlaxoSmithKline Presence-Test Case Proper
RXA-17.3 Name of Coding System MVX Value-Profile Fixed
RXA-17.4 Alternate Identifier
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.4 Alternate Identifier
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Value-Test Case Fixed
RXR-1.2 Text INTRAMUSCULAR Presence-Test Case Proper
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.4 Alternate Identifier
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier RD Value-Test Case Fixed
RXR-2.2 Text Right Deltoid Presence-Test Case Proper
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier VXC50 Value-Test Case Fixed
OBX-5.2 Text Public Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier IIP024 Value-Test Case Fixed
OBX-5.2 Text HeartlandVV-Program Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300023411240207 Value-Test Case Fixed
OBX-5.2 Text Heartland-24 Vaccine 03-28-2024 VIS Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding source Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier PHC70 Value-Test Case Fixed
OBX-5.2 Text Private funds Presence-Test Case Proper
OBX-5.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine funding program eligibility category Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier V01 Value-Test Case Fixed
OBX-5.2 Text Not VFC eligible Presence-Test Case Proper
OBX-5.3 Name of Coding System HL70064 Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text Eligibility captured at the immunization level Presence-Test Case Proper
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document type Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300005911230512 Value-Test Case Fixed
OBX-5.2 Text Hepatitis B Vaccine VIS Presence-Test Case Proper
OBX-5.3 Name of Coding System cdcgs1vis Value-Profile Fixed
OBX-5.4 Alternate Identifier
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vaccine Information Statement Presented Presence-Test Case Proper
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.4 Alternate Identifier
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3 Presence-Test Case Proper
OBX-5 Observation Value 20240405 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.4 Alternate Identifier
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20240405 Presence-Content Indifferent
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.4 Alternate Identifier
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Finley Ira Nash
Mother's Maiden Name
ID Number 7777
Date/Time of Birth 04/05/1966
Administrative Sex Male
Patient Address 700 Locust Ln Springfield OR 97477 USA
Local Number (541)555-0007
Race Asian
Ethnic Group Hispanic or Latino
Multiple Birth Indicator No
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status Active
Immunization Registry Status Effective Date 01/26/2024
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 04/05/2024
Protection Indicator No
Protection Indicator Effective Date 04/05/2024
Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Vaccine Heartland-24_mRNA
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number HVV8071524
Substance Expiration Date 09/27/2029
Substance Manufacturer Name Moderna
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Left Deltoid
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Public
Vaccine funding program eligibility category HeartlandVV-Program
Document type Heartland-24 Vaccine 03-28-2024 VIS
Date Vaccine Information Statement Presented 04/05/2024

Vaccine Administration Information
Element Data
Administered Vaccine ENGERIX-B
Date/Time Start of Administration 04/05/2024
Administered Amount 0.5
Administered Units mL
Administration Notes New immunization record
Administering Provider Daniela Wyatt
Substance Lot Number IIPVAXN03
Substance Expiration Date 09/27/2029
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status Complete
Action Code Add
Route INTRAMUSCULAR
Administration Site Right Deltoid
Entering Organization Oregon Family Medicine
Entered By Daniela Wyatt
Ordered By Ramon Bradshaw

Element Data
Vaccine funding source Private funds
Vaccine funding program eligibility category Not VFC eligible
Document type Hepatitis B Vaccine VIS
Date Vaccine Information Statement Presented 04/05/2024

7.1.6. 7.1.6 - Receive acknowledgment messages from an IIS during the course of processing the patient immunization record

Test Step Type: TA_RESPONDER

Test Story

Description

SUT is able to receive acknowledgment messages from an IIS during the course of processing the patient immunization record.



Pre-condition

The SUT has transmitted administered vaccine.


Daniela Jennifer Wyatt is the administering practitioner.


Post-Condition

An acknowledgement (ACK Z23) is received and processed by the SUT.

Go to step 7.2.1


Test Objectives

The SUT is able to receive an acknowledgment in response to VXU transmissions.


Evaluation Criteria

This is not an evaluated step that must be performed to support other associated steps.


The acknowledgement message is displayed and consumed by the SUT responsible for the content of the administration message.



Message Contents

MSH : MSH Segment Adopting Fields from 2.7.1
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID IIP-IIS-APP
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.40.3
MSH-3.3 Universal ID Type ISO
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIP
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.40.4
MSH-4.3 Universal ID Type ISO
MSH-5 Receiving Application
MSH-5.1 Namespace ID SUT-APP
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.40.1
MSH-5.3 Universal ID Type ISO
MSH-6 Receiving Facility
MSH-6.1 Namespace ID OFM
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.40.2
MSH-6.3 Universal ID Type ISO
MSH-7 Date/Time Of Message
MSH-7.1 Time 20240405120108-0500
MSH-9 Message Type
MSH-9.1 Message Code ACK
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure ACK
MSH-10 Message Control ID IIP-ACK-1
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name Immunization Integration Program
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID IIP
MSH-22.6.2 Universal ID 2.16.840.1.113883.3.72.5.40.9
MSH-22.6.3 Universal ID Type ISO
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 197027
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name Oregon Family Medicine
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID OFM
MSH-23.6.2 Universal ID 2.16.840.1.113883.3.72.5.40.9
MSH-23.6.3 Universal ID Type ISO
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 197028

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID IIP-Transmit-11

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

7.2. 7.2.0 - Clinical Configuration, Updates immunization schedule

Test Story

Description

All SUT used to provide and record immunization to patient requires the most up-to-date immunization schedule as recommended by the CDC Advisory Committee on Immunization Practices (ACIP). This test evaluates the process for updating the schedule as ACIP recommendations change.



Evaluation Criteria

See test step for details.



7.2.1. 7.2.1 - Attests that the immunization schedule is updated regularly to reflect changes in ACIP immunization recommendations

Test Step Type: SUT_MANUAL

Test Story

Description

Each SUT uses an immunization forecasting engine to establish the immunization recommendations to provide to each patient and such forecasting must be updated regularly to reflect new recommendations as they are published by the ACIP. The SUT may use its own forecasting engine or it may access a third-party engine (e.g., but not limited to STC, ICE). 

The SUT must attest to the fact that it incorporates updates to its active immunization schedule, and provide the following discovery data: 

(1) Forecasting engine used; 

(2) Frequency of update to forecasting engine; 

(3) Indication of whether a clinical site may use the SUT with a forecasting engine other than the one incorporated with the SUT product "out of the box"



Pre-condition

SUT uses a forecasting engine to create each patient's immunization schedule.



Post-Condition

SUT attests to updating vaccine schedule data after changes to ACIP recommendations.  Since there is no clearly established interval between an ACIP update and implementation in the SUT schedule, the proctor will request such timeliness information as part of discovery.

Go to step 9.1.1


Test Objectives

To test the ability that the SUT has a process for updating vaccine schedules based on changes to ACIP recommendations.




Evaluation Criteria

This is a non-evaluated test step that must be performed to support other associated steps.


This was an attestation item-previously attested to.





8. 8.0.0 - Capability: SOAP Testing

Test Story

Description

This "test group" includes a single SOAP test:

Connect to an immunization information system (IIS) and to generate and transmit a message conforming to the SOAP 1.2 standard and CDC WSDL 1.0 that may be used for transporting an HL7 message to an immunization information system (IIS).

See test case within the SOAP Connectivity yellow navigation tabs at the top of this tool. All testing for this capability is done outside of the HL7 Context-based menus.


Comments

Unlike other IIP capabilities:

- this is performed outside of the context-based tests

- it is not divided into test cases (functions) and test steps (requirements)



Pre-condition

The SUT is ready to be configured to established connectivity with an IIS.



Post-Condition

Transport is configured to use the SOAP-based CDC WSDL.



Test Objectives

Configure SOAP-based CDC WSDL for Transport: The EHR or other clinical software system configures connectivity using the SOAP-based CDC WSDL and demonstrates compliance with this standard transport.




Evaluation Criteria

Using the test tool and instructions published by NIST at: https://hl7v2-iz-r1-5-testing.nist.gov/iztool/#/soapConn

the SUT is able to successfully execute both SOAP Connectivity Sender (Initiator) test case:

- Test Case: SOAPCON_3_SubmitSingleMessage_Message



Notes

All instructions and test details are available at:

https://hl7v2-iz-cdc-testing.nist.gov/iztool/#/soapConn


9. 9.0.0 - Capability: Basic data quality checks

Test Story

Description

See test case for details.



Evaluation Criteria

See test case for details.



Notes

IZ Administered (RXA-3/4) after Expiration (RXA-16) is excluded from this capability as it is tested through 3.10.3 - Vaccine dose expiration is visually apparent to administering practitioner

Patient information is manually input under test proctor observation.



9.1. Yuiko Kami Nakano 9.1.0 - Basic data quality checks

Test Story

Description

See test case steps for details.



Pre-condition

Daniela Jennifer Wyatt is the practitioner.


Test Objectives

Alerts a user to the following data entry issues:
1. patient born in the future (DOB (PID-7) after TODAY)
2. patient DOB too old (Today-DOB>150 years)
3. patient vaccinated before birth (IZ Administered (RXA-3/4) before DOB (PID-7))



Evaluation Criteria

The SUT makes user aware of the following data entry impossibilities or improbabilities:

Step 9.1.1 Attests: Alert a user when data entered indicates the patient is born in the future (DOB (PID-7) after TODAY)

Step 9.1.2 Attests: Alert a user when a date of birth (PID-30) is entered which indicates a patient is more than 150 years of age (TODAY-DOB > 150 Years)

Step 9.1.3 - Requirement: Shall Alert a user when data entered indicates the patient received a vaccine before birth (DOD (PID-30) before DOB (PID-7))

Vaccine administered before birth: (RXA-3/4) before DOB (PID-7)


9.1.1. 9.1.1 Attestation: Alert a user when data entered indicates the patient is born in the future (DOB (PID-7) after TODAY)

Test Step Type: SUT_MANUAL

Test Story

Description

Attests that if SUT user enters a typo indicating the patient Yuiko Kami Nakano's date of birth is in the future, the SUT then alerts the user of the issue.



Pre-condition

Yuiko Kami Nakano is registered as a patient in the SUT.

Daniela Jennifer Wyatt is the practitioner.



Post-Condition

The SUT alerts a user the patient's date of birth is in the future.

Go to step 9.1.2


Test Objectives

The SUT is able to prevent a user from entering a patient's DOB in the future.



Evaluation Criteria

This is a non-evaluated test step that must be performed to support other associated steps.


This was an attestation item-previously attested to.


Notes
A SUT user attempts register a new patient by entering the following patient information:
ID Number8888
ID TypeMedical record number
Name
FirstYuiko
MiddleKami
LastNakano
Date of Birth (corrected later)04/05/2121


The SUT shall Requests (query) a patient's evaluated immunization history and vaccine forecast from an IIS using an HL7 v2.5.1 Z44 profile message.


If SUT requires additional details use the following:


Sex
Race
Ethnicity
Permanent Address
Address Line 17777 Pine Ln
CitySpringfield
StateOR
Zip Code97477
CountryUSA
Phone Number(541) 555-0017
UsePrimary Residence Number
TypeTelephone
Part of a multiple birth?No
Birth order1
Reminder RecallReminder/recall - any method
Protected?No
IIS StatusActive
Deceased?No

9.1.2. 9.1.2 Attestation: Alert a user when a date of birth (PID-30) is entered which indicates a patient is more than 150 years of age (TODAY-DOB > 150 Years)

Test Step Type: SUT_MANUAL

Test Story

Description

Attests that if SUT user enters a typo indicating the patient Yuiko Kami Nakano is more than 150 years of age, the SUT then alerts the user of the issue.



Pre-condition

Yuiko Kami Nakano is registered as a patient in the SUT.



Post-Condition

The SUT alerts a user the entered patient's date of birth is too long ago.

Yuiko Kami Nakano's date of birth has been corrected in the SUT to 02/27/2021.

Go to step 9.1.3


Test Objectives

The SUT prevents a user from entering a patient's DOB too far in the past.



Evaluation Criteria

This is a non-evaluated test step that must be performed to support other associated steps.

This was an attestation item-previously attested to.



Notes

A SUT user attempts to modify the date of birth for existing patient, Yuiko Kami Nakano, from 02/27/2121 to 02/27/1821

The SUT alerts a user the entered patient's date of birth is too long ago.

Finally, SUT user corrects the patient's date of birth to 02/27/2021.


9.1.3. 9.1.3 - Alert a user when data entered indicates the patient received a vaccine before birth (DOD (PID-30) before DOB (PID-7))

Test Step Type: SUT_MANUAL

Test Story

Description

A SUT user selects the wrong patient (Yuiko Kami Nakano); inadvertently recording a vaccine which occurs before the patient's date of birth. The SUT then actively alerts the user of the issue.



Pre-condition

Yuiko Kami Nakano is registered as a patient in the SUT.


Daniela Jennifer Wyatt is the practitioner.


Post-Condition

The SUT alerts a user that the entered date of vaccine is before the patient's date of birth.

Go to step 8


Evaluation Criteria

The SUT user attempts to enter a vaccine date that is before patient DOB: Yuiko Nakano (DOB 02/27/2021)

Date of Vaccine: 02/27/2020

If SUT requires additional details use the following:

The SUT shall inform a user that the vaccine date recorded is before their date of birth.

A SUT user then removes the vaccine that was recorded and correctly enters the vaccine date as the same day as patient DOB.

The proctor shall consider successful performance if one of the following is observed (a, b, OR c):
a. Entry of the a year prior to the birth year just isn't possible because the SUT doesn't provide a choice of years before the birth year (Active informing)
b. Indication in the UI after the wrong year that the year may be incorrect (e.g., date shown in red or highlighted in some way, but the SUT allows the user to proceed without making a change - Passive)
c. The SUT prevents the user from selecting "Save" and highlights the error to be fixed prior to saving, or provides a pop-up indicator indicating the error, requiring a change to the data before completing (Active)
d. The SUT provides a pop-up indicator indicating the error, requiring a change to the date before completing (Active)